A Proposed Algorithm for the Management of Large Third Ventricular Craniopharyngiomas

Craniopharyngioma represent one of the most challenging brain tumors for the neurosurgeon and pose unique surgical dilemmas when primarily arising from within the third ventricle. A detailed knowledge of surgical anatomy and careful preoperative surgical planning are essential to achieve good clinical results; the iatrogenic morbidity of these tumors can otherwise be severe. A myriad of surgical approaches can be used for these tumors including endoscopic endonasal approaches, “anterolateral” pterional or orbitozygomatic approaches, and “midline” approaches such as the interhemispheric transcallosal or basal trans-lamina terminalis approach. We propose here an algorithm based on imaging findings and patient symptoms to guide what approach, or approaches, are best suited to each patient. The benefits and drawbacks of each surgical approach to this deep-seated area are reviewed in detail and case examples shown.

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