[Lateral approaches to the clivus].

Thanks to ongoing development in microsurgical techniques to treat the skull base some clivus lesions, considered inoperable until a few years ago, can now be removed with relatively low mortality and morbidity. The approaches available for the treatment of lesions in this anatomical area can be broken down into anterior and lateral. The latter offer the surgeon several important advantages such as better control over the main vascular structures and the possibility of opening the intradural space without coming into communication with the pharynx. By virtue of their extreme versatility, the lateral approaches may be used in combination in a single operation or can be performed as staged procedures. Each of the lateral routes, however, has its own advantages and drawbacks. These are presented during a brief description of each technique. The main factor in selection of approach is the anatomical limits of the approach itself. Generally speaking, the largest surgical field is offered by the most destructive approaches. Although they do cause such deficits as unilateral hearing loss, these approaches permit greatly improved control over the vital structures. Nevertheless, when such deficits exist prior to surgery, the morbidity of such approaches is negligible. The histological nature of the disease, the variable relationships with the dura, the main neurovascular structures and other factors should all be considered when deciding how to manage each case. The surgeon must, however, have the range of skills required to perform the diversity of approaches to the lateral skull base so as to provide the patient with the best possible care.