CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S205-S207
DOI: 10.1055/s-0037-1620252
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

The Posterior Transpetrosal Approach in a Case of Large Retrochiasmatic Craniopharyngioma: Operative Video and Technical Nuances

Moujahed Labidi
1  Department of Neurosurgery, Hôpital Lariboisière, Paris, France
2  Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
,
Kentaro Watanabe
1  Department of Neurosurgery, Hôpital Lariboisière, Paris, France
,
Marie-Pier Loit
1  Department of Neurosurgery, Hôpital Lariboisière, Paris, France
,
Shunya Hanakita
1  Department of Neurosurgery, Hôpital Lariboisière, Paris, France
,
Sébastien Froelich
1  Department of Neurosurgery, Hôpital Lariboisière, Paris, France
3  Paris-Diderot University, Paris, France
› Author Affiliations
Funding Local funds.
Further Information

Address for correspondence

Moujahed Labidi, MD, FRCSC
Department of Neurosurgery, Hôpital Lariboisière
Assistance Publique–Hôpitaux de Paris 2
Rue Ambroise Paré, Paris
France   

Publication History

20 October 2017

29 November 2017

Publication Date:
16 January 2018 (eFirst)

 

Abstract

Objectives To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma.

Design Operative video.

Results In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy. However, accelerated growth of the tumor, with renewed visual deficits and mass effect on the hypothalamus and third ventricle, warranted a supplementary resection. A posterior transpetrosal[1] [2] (also called “retrolabyrinthine transtentorial”) was performed to obtain a better exposure of the tumor and the surrounding anatomy (floor and walls of the third ventricle, perforating vessels, optic nerves, etc.)[3]. Nuances of technique and surgical pearls related to the posterior transpetrosal are discussed and illustrated in this operative video, including the posterior mobilization of the transverse–sigmoid sinuses junction, preservation of the venous anatomy during the tentorial incision, identification and preservation of the floor of the third ventricle during tumor resection, and a careful multilayer closure.

Conclusion Retrochiasmatic craniopharyngiomas are difficult to reach tumors that often require skull base approaches, either endoscopic endonasal or transcranial. The posterior transpetrosal approach is an important part of the surgical armamentarium to safely resect these complex tumors.

The link to the video can be found at: https://youtu.be/2MyGLJ_v1kI.


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Zoom Image
Fig. 1 Preoperative and postoperative imaging. Sagittal gadolinium-enhanced T1 preoperative (A) and (B) postoperative images of the endoscopic transtubercular approach for a large retrochiasmatic craniopharyngioma. Preoperative sagittal CISS image (C) and postoperative sagittal gadolinium-enhanced T1 (D) of the posterior transpetrosal approach.
Zoom Image
Fig. 2 Intraoperative images. (A) In posterior transpetrosal approach, posterior mobilization of the transverse–sigmoid junction opens up the surgical corridor between the temporal lobe and posterior fossa (white arrows). (B) Initial dissection of the arachnoid of the interpeduncular fossa and exposure of the tumor. Endoscopic assistance allows detailed inspection of the surgical bed (C) and a better appreciation of the surrounding neurovascular anatomy (D). CN, cranial nerve; L optic N, left optic nerve; R optic N, right optic nerve.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


Quality:

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Conflict of Interest

None.


Address for correspondence

Moujahed Labidi, MD, FRCSC
Department of Neurosurgery, Hôpital Lariboisière
Assistance Publique–Hôpitaux de Paris 2
Rue Ambroise Paré, Paris
France   


  
Zoom Image
Fig. 1 Preoperative and postoperative imaging. Sagittal gadolinium-enhanced T1 preoperative (A) and (B) postoperative images of the endoscopic transtubercular approach for a large retrochiasmatic craniopharyngioma. Preoperative sagittal CISS image (C) and postoperative sagittal gadolinium-enhanced T1 (D) of the posterior transpetrosal approach.
Zoom Image
Fig. 2 Intraoperative images. (A) In posterior transpetrosal approach, posterior mobilization of the transverse–sigmoid junction opens up the surgical corridor between the temporal lobe and posterior fossa (white arrows). (B) Initial dissection of the arachnoid of the interpeduncular fossa and exposure of the tumor. Endoscopic assistance allows detailed inspection of the surgical bed (C) and a better appreciation of the surrounding neurovascular anatomy (D). CN, cranial nerve; L optic N, left optic nerve; R optic N, right optic nerve.