Affiliation:
1. Department of Neurosurgery, Lenox Hill Hospital, New York, New York
Abstract
Abstract
Retrochiasmatic craniopharyngiomas are difficult to treat due to their close proximity to critical neurovascular structures. Several surgical approaches with distinct advantages and limitations have been described to access these tumors, including extended transnasal endoscopic approach (ETEA), subtemporal, translamina terminalis, and transpetrosal approach.1-3
We present a 51-yr-old male with a large retrochiasmatic craniopharyngioma extending into the third ventricle, causing obstructive hydrocephalus. Preoperative magnetic resonance imaging (MRI) showed a tumor cyst abutting the fornices expanding the space between two internal cerebral veins (ICV). After surgical consent, we decided to take advantage of this corridor to approach the tumor in its long axis. Surgical goal was to achieve cyst decompression with “safe maximal” resection of the solid component at last to preserve the pituitary function. Though the long axis of the tumor could be approached using ETEA, we preferred this approach in view of cyst decompression early in the surgery while completely avoiding risks such as cerebrospinal fluid (CSF) rhinorrhea, internal carotid artery (ICA) injury, and sinonasal complications. We utilized a 3-dimensional 4 K exoscope, which provides an excellent ergonomic position, and a high-resolution immersive view compared to a microscope or endoscope. Cyst decompression and near-total resection of the solid component was achieved. Postoperatively, his headaches improved and he was neurologically intact with intact neuroendocrine function. Approach-related risks may include but not limited to hemorrhage due to the rupture of venous sinuses or ICV, stalk or hypothalamus injury, and memory disturbances due to forniceal injury. To conclude, the transcallosal, interforniceal approach to retrochiasmatic craniopharyngiomas may provide a safe surgical corridor in select cases.
Patient consented to the proposed procedure. All radiological images have been anonymized. IRB/ethics committee approval was not required.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Clinical Neurology,Surgery
Reference3 articles.
1. The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle;Cavallo;Neurosurg Rev,2013
2. Transcortical-transforaminal microscopic approach for purely intraventricular craniopharyngioma;Chamoun;Neurosurg Focus,2013
3. Modified one-piece extended transbasal approach for translaminar terminalis resection of retrochiasmatic third ventricular craniopharyngioma;Liu;Neurosurg Focus,2013
Cited by
7 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献