CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S208-S210
DOI: 10.1055/s-0037-1620248
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Contralateral Minimum Anterior and Posterior Combined Petrosal Approach for Retrochiasmatic Craniopharyngiomas: An Alternative Technique

Sachin Ranganatha Goudihalli
1  Department of Neurosurgery, Fortis Hospital, Bangalore, India
3  Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Hiroki Morisako
3  Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Wimba Prastarana
2  Department of Neurosurgery, Airlangga University, Surabaya, Indonesia
,
Takeo Goto
3  Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Hiroki Ohata
3  Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Kenji Ohata
3  Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
› Author Affiliations
Further Information

Publication History

27 October 2017

29 October 2017

Publication Date:
11 January 2018 (eFirst)

  

Abstract

Retrochiasmatic craniopharyngiomas (RC) are a challenge for the neurosurgeon to treat surgically, restrained by their location in the interpeduncular fossa, surrounded by vital neurovascular structures, narrow corridor and poor visibility. Many approaches are possible and elucidated in the literature, which the surgeon chooses, based on multiple factors, such as the size of tumor, calcification, laterality, preoperative neurological deficits and the endocrine function status, recurrence, postradiotherapy status, or significant superior and/or posterior extension.[1] [2]

We describe a contralateral minimum anterior and posterior (CL-MAPC) petrosal approach for a case of recurrent RC, in a 37-year-old female patient operated before using a pterional approach, now presented with left homonymous hemianopia and panhypopituitarism ([Fig. 1]). We preferred a contralateral approach to protect the ipsilateral optic tract (OT) from retraction injury, which formed an obstacle to the tumor from ipsilateral side. Apart from various benefits described by the author previously for RC, using MAPC petrosal approach, the CL-MAPC offers a safe corridor, protecting the ipsilateral OT, visualization of tumor origin usually posterior to chiasm, wider corridor if PCoM could be sacrificed, as it was done in this case, and pituitary stalk identification, with a probability of its functional preservation, unlike a necessity of pituitary transposition in EEA, though the endocrine outcome is poor after a radical resection irrespective of the approach chosen.[1] [3] [4] There was complete excision of the tumor with preservation of visual function postoperatively. We recommend the use of CL-MAPC as an alternative to EEA in some specific indications when the tumor is large, calcified, obscuring OT on the ipsilateral side and with significant lateral extension, which may be limiting factors in EEA ([Fig. 2]).

The link to the video can be found at: https://youtu.be/gWCJmh4_evs.