Luigi Maria Cavallo1, Domenico Solari2, Felice Esposito2, Alessandro Villa2, Giuseppe Minniti3, Paolo Cappabianca2. 1. Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. Electronic address: lcavallo@unina.it. 2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. 3. Department of Radiation Oncology, Sant'Andrea Hospital, University Sapienza, Rome, Italy.
Abstract
BACKGROUND: Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various transcranial approaches with the transsphenoidal route reserved for very selected cases. With the widespread use of endoscopes in endonasal surgery in the past decade, the extended endoscopic endonasal transtuberculum and transplanum approaches have been proposed as an alternative surgical route for removal of different types of suprasellar tumors, including solid craniopharyngiomas in patients with normal pituitary function and small sella. METHODS: A detailed report is presented of the technique used by the authors for the endoscopic endonasal approach for the resection of craniopharyngiomas. For each type of craniopharyngioma, hints and anatomic "main landmarks" are provided throughout each step of the procedure. CONCLUSIONS: The endoscopic endonasal approach offers advantages in the management of craniopharyngiomas that historically have been approached via the transsphenoidal route (i.e., purely intrasellar or intra-suprasellar infradiaphragmatic, preferably cystic lesions in patients with panhypopituitarism). Use of the "extended" endoscopic endonasal approach overcomes the limits of the transsphenoidal route to the sella enabling the management of different purely suprasellar and retrosellar cystic/solid craniopharyngiomas, regardless of the sellar size or pituitary function.
BACKGROUND:Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various transcranial approaches with the transsphenoidal route reserved for very selected cases. With the widespread use of endoscopes in endonasal surgery in the past decade, the extended endoscopic endonasal transtuberculum and transplanum approaches have been proposed as an alternative surgical route for removal of different types of suprasellar tumors, including solid craniopharyngiomas in patients with normal pituitary function and small sella. METHODS: A detailed report is presented of the technique used by the authors for the endoscopic endonasal approach for the resection of craniopharyngiomas. For each type of craniopharyngioma, hints and anatomic "main landmarks" are provided throughout each step of the procedure. CONCLUSIONS: The endoscopic endonasal approach offers advantages in the management of craniopharyngiomas that historically have been approached via the transsphenoidal route (i.e., purely intrasellar or intra-suprasellar infradiaphragmatic, preferably cystic lesions in patients with panhypopituitarism). Use of the "extended" endoscopic endonasal approach overcomes the limits of the transsphenoidal route to the sella enabling the management of different purely suprasellar and retrosellar cystic/solid craniopharyngiomas, regardless of the sellar size or pituitary function.
Authors: Mohamed A R Soliman; Sydney Eaton; Elise Quint; Abdullah F Alkhamees; Saba Shahab; Avalon O'Connor; Erika Haberfellner; Jacob Im; Abdurrahim A Elashaal; Francis Ling; Mustafa Elbreki; Tommy Dang; Dante J Morassutti; Abdalla Shamisa Journal: World Neurosurg Date: 2020-04-13 Impact factor: 2.104