Introduction: Lesions affecting the clivus and paraclival regions are relatively infrequent, but they can be difficult to diagnose and manage. Clivus destruction can be caused by a wide range of origins including primary clivus masses, pituitary, intracranial, nasopharyngeal, sinonasal lesions, metastasis and skull base osteomyelitis.
Aims: An additional benefit of modern multidisciplinary endoscopic transnasal skull base surgery is that proficient rhinologists can take biopsies from these lesions with low morbidity via transnasal endoscopy. The study aims to assess how the increasing priority of biopsies has changed our basic practice.
Methods: A retrospective study was carried out based on patient records between 2019 and 2024.
Results: The authors’ previous practice is based on radiology and symptoms, while the current algorithm also incorporates the leading role of biopsy. The authors illustrate how conceptual change occurs by utilizing representative cases.
Conclusion: Biopsy, which can be performed with little risk in many cases, significantly improves the quality of decision-making and thus enables the planning of modern histologically-guided therapy.
