Reconstructive challenges in the extended endoscopic transclival approach.

OBJECTIVE: We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges. METHODS: We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain. RESULTS: The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (p < 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (p < 0.05). CONCLUSION: Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.

Morphological changes along an altitude gradient and their consequences for an andean giant rosette plant.

Selected morphological features were measured in five populations of the giant rosette plant Espeletia schultzii occurring along an elevation gradient from 2600 to 4200 m in the Venezuelan Andes. Pith volume per amount of leaf area increases with elevation resulting in significantly larger water storage capacity at higher elevations. Thickness of leaf pubescence and, therefore, leaf boundary layer resistance, also increases with elevation resulting in both potentially higher leaf temperatures relative to air temperature and higher leaf to air vapor pressure gradients. The net effect on transpiration rate would depend on ratios of stomatal to boundary layer resistance and leaf energy balance. At higher elevations the central rosette leaves are more vertically oriented and the leaf bases show a pronounced curvature as the intersection with the main axis is approached. This gives these rosettes a distinctly paraboloid appearance and probably enhances capture and retention of incident long and shortwave radiation by the apical bud and expanding leaves. Features which result in enhanced water storage capacity and higher plant temperatures relative to air temperature without greatly increasing water loss are adaptive in high altitude paramo habitats where water availability and growth are limited by year round low temperatures (mean 2-3° C).