CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S201-S202
DOI: 10.1055/s-0037-1620244
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Extended Endoscopic Approach for Resection of Craniopharyngiomas

João Paulo Almeida
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Suganth Suppiah
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Claire Karekezi
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Miguel Marigil-Sanchez
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Jay S. Wong
2  Department of Otolaryngology/Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Allan Vescan
2  Department of Otolaryngology/Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Fred Gentili
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
,
Gelareh Zadeh
1  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Address for correspondence

João Paulo Almeida, MD
Division of Neurosurgery, Toronto Western Hospital
4th Floor 399 Bathurst Street, Toronto, ON M5T 2S8
Canada   

Publication History

12 October 2017

12 December 2017

Publication Date:
16 January 2018 (eFirst)

 

    Abstract

    Objectives Extended endoscopic approaches are useful for resection of selected craniopharyngiomas. Midline, extraventricular, and predominantly cystic lesions are good candidates for endoscopic resection. In this video, we demonstrate the endoscopic endonasal resection of a large suprasellar craniopharyngioma and discuss the nuances of the surgical technique.

    Design/Setting Surgical video of an extended endoscopic approach for resection of a suprasellar craniopharyngioma.

    Results We report the case of a 56-year-old woman who presented with bitemporal hemianopsia and visual acuity deterioration secondary to a large suprasellar solid–cystic lesion. The patient underwent an extended endoscopic transtuberculum approach for resection of the lesion, which was diagnosed as a papillary craniopharyngioma. This video discusses the anatomy and surgical technique applied for endoscopic resection of such lesions.

    Conclusion Endoscopic endonasal surgery is a useful technique for management of craniopharyngiomas. It is associated with good clinical outcomes in selected cases. Complications, such as postoperative CSF leak, may occur and should be carefully managed.

    The link to the video can be found at: https://youtu.be/EneOCiQE7yo.


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    Zoom Image
    Fig. 1 Preoperative MRI scan demonstrating a suprasellar tumor, suggestive of craniopharyngioma. The coronal T1 contrast-enhanced scan (left) shows the lesion, located medial to the clinoid and supraclinoid internal carotid arteries and superior to the pituitary gland (as demonstrated by the arrows), compressing the optic chiasm. The sagittal imaging (right) demonstrates the relationship of the lesion with the floor of the III ventricle and basal cisterns (right). ICA, internal carotid artery; MRI, magnetic resonance imaging.
    Zoom Image
    Fig. 2 Transtuberculum approach: surgical anatomy. The anatomical direction demonstrates the anatomical structures related to the transtuberculum approach. cICA, clinoid segment of the internal carotid artery; LOCR, lateral optic carotid recess; pcICA, paraclival segment of the internal carotid artery; OC, optic canal. Dashed line demonstrates the area of bone opening for the transtuberculum approach (copyright © Joao Paulo Almeida, MD).
    Zoom Image
    Fig. 3 Exposure of the III ventricle and interpeduncular cistern after tumor resection. The basilar tip, PCA and SCA, III nerve, and PcomA are visible. PCA, posterior cerebral; PcomA, posterior communicating artery; SCA, superior cerebellar.

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    Quality:

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    Conflict of Interest

    None.

    Address for correspondence

    João Paulo Almeida, MD
    Division of Neurosurgery, Toronto Western Hospital
    4th Floor 399 Bathurst Street, Toronto, ON M5T 2S8
    Canada   

      
    Zoom Image
    Fig. 1 Preoperative MRI scan demonstrating a suprasellar tumor, suggestive of craniopharyngioma. The coronal T1 contrast-enhanced scan (left) shows the lesion, located medial to the clinoid and supraclinoid internal carotid arteries and superior to the pituitary gland (as demonstrated by the arrows), compressing the optic chiasm. The sagittal imaging (right) demonstrates the relationship of the lesion with the floor of the III ventricle and basal cisterns (right). ICA, internal carotid artery; MRI, magnetic resonance imaging.
    Zoom Image
    Fig. 2 Transtuberculum approach: surgical anatomy. The anatomical direction demonstrates the anatomical structures related to the transtuberculum approach. cICA, clinoid segment of the internal carotid artery; LOCR, lateral optic carotid recess; pcICA, paraclival segment of the internal carotid artery; OC, optic canal. Dashed line demonstrates the area of bone opening for the transtuberculum approach (copyright © Joao Paulo Almeida, MD).
    Zoom Image
    Fig. 3 Exposure of the III ventricle and interpeduncular cistern after tumor resection. The basilar tip, PCA and SCA, III nerve, and PcomA are visible. PCA, posterior cerebral; PcomA, posterior communicating artery; SCA, superior cerebellar.