Combined Approaches for the Treatment of Craniopharyngioma

Introduction: The authors describe the use of a combined fronto-orbitozygomatic temporopolar craniotomy to maximize the operative corridor and thereby increase the probability of maximum tumor resection while minimizing morbidity and mortality.

Methods: They applied this approach in 54 children with craniopharyngiomas that involved the sellar and parasellar regions, third ventricle, cavernous sinus, and interpeduncular fossa regions.

Results: The surgical results are summarized with a description of the operative procedure and comparison with other previously described surgical approaches, including the subfrontal, bifrontal, pterional, translamina terminalis, transsphenoidal, transcallosal, and transcortical approaches.

Conclusion: Because each particular technique has both strengths and weaknesses, the surgeon must choose the approach that provides optimum exposure to maximize the chances for total resection. The specific operative corridor chosen will ultimately depend on the anatomy of each individual tumor as noted on preoperative magnetic resonance (MR) images and computerized tomography (CT) scans. The tenets underlying the approach include: (1) obtaining the shortest trajectory to the suprasellar region, interpeduncular fossa, and anterior third ventricle; (2) more aggressive bone removal (orbital roof, middle fossa, and sphenoid wing) to minimize retraction injury; (3) posterior mobilization of the temporal tip with preservation of the temporal tip veins; and (4) the skeletonization/decompression of cranial nerves and vascular structures to maximize their preservation during surgical manipulation.