Surgical removal of craniopharyngiomas by the transcranial approach through the lamina terminalis and sphenoid sinus.

We describe a method of attempting total removal of a craniopharyngioma using a subfrontal approach; dissection of the tumor from the brain stem, hypothalamus, and optic chiasm through the lamina terminalis; and then piecemeal removal of the tumor through the sphenoid sinus. Eleven patients treated by this approach are reported. In these patients, prior subfrontal operation did not affect outcome, but a prior transventricular operation or prior high dose radiation therapy made complete tumor removal less likely. We believe that this operation is one way to remove a craniopharyngioma that affords satisfactory exposure and reduces the chances of injury to the frontal lobes, hypothalamus, and optic pathways.