Table 2.
Technical aspects, outcomes, and complications related to the surgical approach of the studies included in the systematic review. Abbreviations: CSF—Cerebro-Spinal Fluid; GTR—Gross Total Resection; N/R—Not Reported; STR—Subtotal Resection; NTR—Near—Total Resection; PR—Partial Resection; CN—Cranial Nerve; ICA—Internal Carotid Artery.
| Authors, Year | Symptoms | Clivus Site | Cervical Level | Intradural Extension | EOR | Postop CSF Leak | Other Complications | Time Surgery | Hospitalization (Days) | Recurrency |
|---|---|---|---|---|---|---|---|---|---|---|
| Messerer et al., 2016 [27] | 2 neck pain and dysphagia 1 CSF leakage and meningitis |
3 upper | No | No | 3 GTR | No | No | Primary surgery | N/R | N/R |
| Zweckberger et al., 2020 [55] | 24 double vision 17 headaches 7 vertigo 9 visual acuity deteriorations 9 dysphagia 6 insecure gait 4 ptosis 1 coordination disorder |
12 upper, 26 middle | N/R | 17 | 12 GTR 28 STR |
9 | 2 hemorrhages 3 strokes 2 hydrocephalus |
29 primary surgeries 41 surgeries upon recurrence |
N/R | N/R |
| Fatemi et al., 2008 [14] | 8 diplopia (VI nerve palsy) 3 V nerve palsy 7 headaches 2 acuity visual losses 2 unsteady gait 2 spontaneous CSF leaks |
9 upper, 5 middle | No | 7 | 6 GTR 6 NTR 2 STR |
8 | 1 transient diabetes insipidus | Primary surgery | N/R | N/R |
| Vellutini et al., 2014 [44] | 16 VI nerve palsy 9 headaches |
26 lower, 2 middle | No | 12 | 13 GTR 7 STR 6 PR |
6 | 2 meningitis 1 stroke |
N/R | N/R | N/R |
| Rahme et al., 2018 [33] | 12 diplopia 8 headaches 3 cranial nerve palsy 2 paresthesia 1 neck pain 1 unsteady gait 1 tinnitus 1 dysphagia 1 coma 1 decreased smell 1 airway obstruction |
3 lower | 1 | 9 | 9 GTR | 6 | 5 cranial nerve palsy 3 meningitis 2 strokes |
Primary surgery | N/R | N/R |
| Kassam et al., 2008 [19] | 2 headaches 1 VI nerve palsy 1 III nerve palsy |
N/R | N/R | N/R | 3 GTR 1 STR |
3 | No | N/R | N/R | N/R |
| Koutouroulsiou et al., 2012 [22] | 28 VI nerve palsy 17 headaches 4 nasal obstructions 5 III nerve palsy 5 trigeminal neuralgia 5 X nerve palsy 5 XII nerve palsy |
23 lower, 21 middle, 7 upper | 7 | 29 | 29 GTR + 11 GTR in previously treated patients 4 NTR + 5 NTR in previously treated patients 2 STR + 4 STR in previously treated patients 5 partial in previously treated patients |
12 | 4 cranial nerve palsy 2 ICA injuries 2 meningitis |
35 primary surgeries 25 recurrent surgeries |
4,5 | N/R |
| Kutlay et al., 2018 [23] | N/R | N/R | N/R | N/R | 3 GTR 2 STR |
No | 2 VI nerve palsy (1 transient) | N/R | Range 3–36 (median 5) | N/R |
| Kong et al., 2021 [21] | N/R | 22 upper, 38 middle | N/R | N/R | 53 GTR 5 STR |
5 | 2 meningitis 3 VI nerve palsy |
Primary surgery | N/R | N/R |
| Nation et al., 2018 [29] | 1 VI nerve palsy | 2 upper | N/R | No | N/R | No | 1 velopharyngeal insufficiency | Primary surgery | N/R | N/R |
| Yousaf et al., 2019 [49] | 3 VI nerve palsy 3 headaches 2 transient diplopia 2 III nerve palsy |
8 upper, 2 middle, 1 lower + occipitocervical junction | 1 | No | 4 GTR 4 NTR 2 STR |
2 | 1 meningitis 1 hypopituitarism 1 diabetes insipidus |
Primary surgery | N/R | N/R |
| Zoli et al., 2018 [54] | 2 VI nerve palsy 4 XII nerve palsy 1 dysphagia 1 cervical pain |
6 middle | 6 | 4 | 2 GTR 4 STR |
No | 1 pneumonia | Primary surgery | N/R | N/R |
| Kim et al., 2016 [20] | 20 VI nerve palsy 7 headaches 2 acuity visual impairments |
17 upper, 8 middle, 17 lower | N/R | 19 | 28 GTR 14 STR |
7 | 1 VI nerve palsy | 34 primary surgeries 8 recurrences |
N/R | N/R |
| Shkarubo et al., 2018 [36] | 78 oculomotor disorders 35 V nerve palsy 28 dysphagia 13 acuity visual impairments 9 hemiparesis 34 headaches 11 coordination disorders |
N/R | N/R | N/R | 67 GTR 22 STR 10 partial |
N/R | N/R | Primary surgery | N/R | N/R |
| Zacharias et al., 2019 [50] | 4 VI nerve palsy Headache (not specified numbers) |
6 upper | 1 | 7 | N/R | 1 | No | 5 primary surgeries 2 recurrences |
5 | N/R |
| Metcalfe et al., 2021 [28] | N/R | N/R | N/R | N/R | N/R | N/R | 1 | 1 radiation toxicity and carotid stenosis 1 postop infection |
N/R | N/R |
| Butenschoen et al., 2023 [9] | 14 VI nerve palsy 9 IX nerve palsy 19 headaches |
5 upper, 4 middle, 26 lower | No | N/R | N/R | N/R | N/R | N/R | N/R | N/R |
| Li et al., 2020 [24] | N/R | No | N/R | N/R | 54 GTR 91 STR 57 partial resections (79–90%) 15 partial resections (<70%) |
N/R | N/R | N/R | N/R | N/R |
| Chibbaro et al., 2013 [11] | 43 VI nerve palsy 22 headaches 11 ophthalmoplegia 11 acuity visual impairments |
22 upper | 3 | 19 | 35 GTR 9 NTR 10 partial resections |
4 | 5 meningitis | 32 primary surgeries 22 recurrences |
N/R | N/R |
| Spiessberg et al., 2022 [40] | 2 headaches 1 dysarthria 1 VI nerve palsy 1 XII nerve palsy 1 V nerve palsy |
5 upper, 2 middle | 1 | 2 | 4 GTR | 1 | 1 VI nerve palsy 1 panhypopituitarism |
Primary surgery | N/R | N/R |
| Arbolay et al., 2009 [7] | 2 headaches 2 VI nerve palsy |
N/R | N/R | N/R | 1 GTR 1 STR |
No | No | Primary surgery | N/R | N/R |
| Ngu et al., 2021 [56] | 5 headaches 2 diplopia |
1 upper, 1 middle, 2 lower | 1 | 2 | 4 GTR 1 STR |
No | 1 syndrome of inappropriate antidiuretic hormone | 4 primary surgeries 1 recurrency |
16,6 | N/R |
| Ceylan et al., 2021 [10] | 37 headaches 29 acuity visual impairments 10 nausea 15 diplopia 34 hypopituitarism |
19 upper, 9 middle, 25 lower | 4 | 21 | 47 GTR 25 STR |
7 | 2 VI nerve palsy 4 hydrocephalus |
N/R | N/R | N/R |
| Dehdashti et al., 2008 [13] | 5 headaches 2 unsteady gait 6 diplopia 1 VI nerve palsy 1 lower cranial nerve deficit |
8 upper, 4 middle | No | 7 | 6 GTR 6 STR |
4 | 1 IX nerve palsy 1 motor hemisyndrome 1 hydrocephalus 1 tension pneumocephalus |
9 primary surgeries 3 recurrences |
Median 8 | N/R |
| Shin et al., 2015 [35] | N/R | N/R | N/R | N/R | 14 GTR | No | 4 transient amnesia and III nerve palsy | 11 primary surgeries 7 recurrences |
N/R | N/R |
| Fraser et al., 2010 [16] | 2 diplopia 3 VI nerve palsy 2 III nerve palsy |
5 upper, 2 middle | No | 3 | 5 GTR 2 NTR |
No | 1 pulmonary embolism | Primary surgery | N/R | N/R |
| Solares et al., 2005 [38] | 1 nasal obstruction 2 acuity visual impairments |
2 upper, 1 middle | No | N/R | N/R | N/R | No | 1 primary surgery 2 recurrences |
2 | N/R |
| Soloperto et al., 2019 [39] | N/R | 4 upper, 2 middle, 2 lower | No | N/R | 3 GTR 5 STR |
No | No | 5 primary surgeries 4 recurrences |
11 | 3 |
| Stippler et al., 2008 [41] | 5 headaches 2 III nerve palsy 6 VI nerve palsy 3 ophthalmoplegia |
5 upper, 8 middle, 12 lower | 3 | 9 | 9 GTR 4 NTR 7 STR |
5 | 1 brainstem hemorrhage 2 transient neurological deficits 1 ICA rupture |
12 primary surgeries 8 recurrences |
N/R | N/R |
| Frank et al. [15] | 9 VI nerve palsy 5 headaches 1 dysphagia |
11 upper | No | N/R | 5 GTR 5 STR 1 partial resection |
No | N/R | 7 primary surgeries 4 recurrences |
5 | 1 |
| Garzaro et al., 2015 [17] | 4 headaches 6 diplopia |
4 upper, 1 middle, 4 lower | No | N/R | 6 GTR 1 NTR 2 partial resections |
2 | 1 V I nerve palsy 1 hypokaliemia |
7 primary surgeries 2 recurrences |
10 | 2 |
| Holzmann et al., 2010 [18] | 2 VI nerve palsy 2 III nerve palsy 3 V nerve deficits |
N/R | N/R | N/R | 11 GTR 1 NTR 1 STR |
1 | N/R | N/R | N/R | N/R |
| Xin et al., 2022 [45] | N/R | N/R | N/R | N/R | 3 GTR | N/R | 1 VI nerve palsy | Primary surgery | N/R | N/R |
| Zhang et al., 2008 [51] | 3 diplopia 3 headaches 2 nasal obstructions 3 VI nerve palsy |
7 upper, 6 middle, 8 lower | 2 | 4 | 6 GTR 1 STR |
No | 1 subarachnoid hemorrhage | 5 primary surgeries 3 recurrences |
N/R | N/R |
| Quon et al., 2019 [32] | 2 VI nerve palsy 2 headaches 1 diplopia |
N/R | N/R | N/R | 2 GTR | N/R | N/R | N/R | N/R | N/R |
| Yoo et al., 2023 [48] | 8 diplopia 2 headaches 1 dysphagia 2 trigeminal neuralgia |
4 upper, 5 middle, 6 lower | 2 | 6 | 6 GTR 9 NTR 2 STR |
1 | N/R | 12 primary surgeries 5 recurrences |
N/R | N/R |
| Baldassarre et al., 2021 [8] | 5 neck pain 2 VI nerve palsy 1 dysphagia 1 rhinolalia |
4 lower | 4 | 1 | 6 GTR 2 partial resections |
1 | 1 XII nerve palsy 1 hydrocephalus 1 pulmonary aspergillosis |
7 primary surgeries 1 recurrency |
N/R | N/R |
| Zoli et al., 2018 [54] | 12 acuity visual impairments 25 V nerve neuralgia 1 dysphagia 9 diplopia 4 hemiparesis 2 VII and VIII deficits |
45 upper, 12 middle | No | 25 | 47 GTR 28 STR 5 partial resections |
2 | 2 ICA injuries 1 hematoma 7 VII nerve palsy |
37 primary surgeries 28 recurrences |
N/R | N/R |
| Taniguchi et al., 2012 [43] | 2 VI nerve palsy | 1 middle | No | 1 | 4 GTR | 1 | 1 VI nerve palsy | 1 primary surgery 3 recurrences |
N/R | N/R |
| Tan et al., 2012 [42] | 5 headaches 4 VI nerve palsy 2 diplopia |
N/R | N/R | N/R | 7 GTR 7 STR |
3 | 1 hydeocephalus 1 aspiration pneumonia |
7 primary surgeries 7 recurrences |
14 | N/R |
| Passeri et al., 2023 [30] | 88 diplopia 84 VI nerve palsy 64 neck pain 65 headaches 53 XII nerve palsy |
50 upper, 95 middle, 65 lower | 95 | 115 | 92 GTR 72 NTR 33 STR 13 partial resections |
32 | 47 worsening cranial nerve palsy | 166 primary surgeries 44 recurrences |
N/R | N/R |
| Schur et al., 2022 [37] | N/R | 34 upper, 31 middle, 37 lower | 16 | 30 | N/R | N/R | N/R | N/R | N/R | N/R |
| Saito et al., 2012 [34] | VI nerve palsy (not specified number) | 5 upper, 1 middle, 4 lower | No | 4 | 3 GTR 1 STR 2 partial resections |
No | 1 meningitis 1 hydrocephalus |
6 primary surgeries |
N/R | N/R |
| Ramm-Pettersen et al., 2017 [31] | 5 diplopia 3 headaches 1 facial hypoesthesia |
3 upper, 3 lower | N/R | 2 | 3 GTR 1 NTR 2 partial resections |
1 | No | 6 primary surgeries | N/R | N/R |
| McDowell et al., 2021 [25] | 7 diplopia 6 headaches 4 swallowing difficulties |
14 upper, 1 middle, 3 lower | 2 | 14 | 14 GTR 6 NTR |
3 | 2 VI nerve palsy 1 Horner’s syndrome 1 epidural hematoma |
15 primary surgeries 4 recurrences |
N/R | N/R |
| Yano et al., 2014 [46] | 6 VI nerve palsy | N/R | N/R | N/R | 4 GTR 2 STR |
1 | N/R | N/R | N/R | N/R |
| Choi et al., 2010 [12] | 86% neck pain 18.6% myelopathy |
N/R | N/R | N/R | N/R | 6.2% | 25% tumor recurrence 4.1% chest infection 3.1% meningitis 3.1% velopharyngeal incompetence 2.1% new cranial nerve palsy 1% wound infection—pharyngeal 3.1% sepsis 3.1% dysphagia 2.1% fixation failure 1% vertebral artery stroke |
N/R | N/R | N/R |
| Menezes et al., 2014 [26] | 100% neck pain 2 w/quadriparesis 1 w/swallowing difficulty and XI nerve palsy |
1 middle | 2 C2 1 C1 1 C2-C3 1 C1-C2 to clivus |
1 | GTR | N/R | No | Primary surgery | N/R | N/R |
| Yang et al., 2011 [47] | Neck pain Tetraparesis |
No | 2 C2-C3 | N/R | GTR | 1 | 1 swallowing difficulty (liquid) | N/R | N/R | Yes (13–18 mo postop) |
| Zhong et al., 2021 [52] | N/R | No | 102 C2 | N/R | 21 en-bloc resections 81 total piecemeal resections |
8 | 9 dysphagia 8 pneumonia 7 dyspnea 5 surgical site infections 2 hematoma 2 pharyngeal dehiscence 1 neurological deficit 1 symptomatic venous thromboembolism 1 cerebral infarction |
Primary surgery | 21.12 ± 6.32 | N/R |