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J Neurol Surg A Cent Eur Neurosurg 2014; 75(05): 354-364
DOI: 10.1055/s-0033-1358609
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Transciliary Supraorbital Approach (Eyebrow Approach) for Resection of Retrochiasmatic Craniopharyngiomas: An Alternative Approach, Case Series, and Literature Review

Rabih G. Tawk
1   Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
3   Department of Neurosurgery, Kaleida Health, Buffalo, New York, United States
,
Mandy J. Binning
1   Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
3   Department of Neurosurgery, Kaleida Health, Buffalo, New York, United States
,
Justin M. Thomas
1   Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
3   Department of Neurosurgery, Kaleida Health, Buffalo, New York, United States
,
Adnan H. Siddiqui
1   Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
2   Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
3   Department of Neurosurgery, Kaleida Health, Buffalo, New York, United States
,
Walter Grand
1   Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, United States
3   Department of Neurosurgery, Kaleida Health, Buffalo, New York, United States
› Author Affiliations
Further Information

Publication History

14 September 2012

28 June 2013

Publication Date:
04 June 2014 (online)

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Abstract

Introduction Craniopharyngiomas are known for an irregular growth pattern and extension into the retrochiasmatic space with adherence to adjacent structures. We describe the use of the transciliary supraorbital approach (eyebrow approach) for resection of craniopharyngiomas with retrochiasmatic extension.

Methods Our clinical database was reviewed to identify operative cases of craniopharyngiomas between July 1998 and January 2011. Only patients who had retrochiasmatic extension and underwent an eyebrow approach were included in this analysis. Endoscopy was used to aid surgical resection at the discretion of the surgeon. Six patients were identified (three from a retrospective review and three during the course of prospective follow-up evaluation).

Results The group included three men and three women (mean age: 41.2 years; range: 28–57 years). All patients had visual and hormonal deficits at presentation. Complete resection was achieved in four patients. Endoscopic assistance was used in three patients. Opening of the frontal sinus occurred in two cases during surgery; an additional surgical procedure was required for repair of a cerebrospinal fluid leak in one of these cases. The duration of clinical follow-up ranged from 18 to 97 months. All patients had excellent cosmetic results, visual improvement to a serviceable level, and a Karnofsky performance scale score ≥80.

Conclusions The eyebrow approach is safe for resection of craniopharyngiomas with retrochiasmatic extension. This approach offers a reasonable surgical corridor for resection of the retrochiasmatic tumor component and can be enhanced using endoscopic assistance.

Keywords

craniopharyngioma - supraorbital approach - eyebrow - transciliary - endoscopic - retrochiasmatic

Note

The study reported here was conducted in Buffalo, New York, United States, where all authors were working at the time. Dr. Binning is presently affiliated to Department of Neurosciences, Stroke and Cerebrovascular Center of New Jersey, Capital Health, Trenton, New Jersey, United States. Dr. Tawk is presently affiliated to Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States.


 

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