Craniopharyngiomas: The Advantage of an Infrasellar Approach with Posterior Clinoidectomy

Background: Location classifications of craniopharyngiomas for the infundibulum have been used to guide various approach strategies. However, approaching Type III tumors (retroinfundibular) with a narrow chiasm-pituitary corridor (CPC) has been considered a contraindication to an endonasal endoscopic approach (EEA) due to the high risk of visual deterioration and consequent subtotal resection (STR). Posterior clinoidectomy may allow direct retrosellar and retroinfundibular access without the manipulation of the neurovascular structures that lie around the perimeter of this region. In this study, we describe the advantage of using an infrasellar approach with posterior clinoidectomy in retro infundibular craniopharyngiomas.

Methods: A retrospective review was conducted to determine the outcome of 15 consecutive patients with retroinfundibular craniopharyngiomas who underwent endonasal endoscopic resections between February 2018 and February 2019. The topographical relationship of the tumor to the third ventricle, stalk, and optic chiasm was investigated, with special attention paid to clinic outcomes and how the posterior clinoidectomy improved the resections.

Results: Gross and near-total resections were achieved in 11 patients (73.3%) and 4 patients (26.6%), respectively. No postoperative complications were found related to the posterior clinoidectomy. Narrow CPCs and large CPCs were found in 5 patients (33%) and 10 patients (66%), respectively. Posterior clinoidectomy allowed not only for an increased surgical area in the sagittal plane, but also in the coronal plane. This advantage was observed especially in patients with narrow CPCs (p < 0.05).

Conclusion: An EEA is an effective surgical approach for retroinfundibular craniopharyngiomas. Posterior clinoidectomy is safe and useful, especially in patients with narrow CPCs.

No conflict of interest has been declared by the author(s).