Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma

Alexandre B. Todeschini; Alaa S. Montaser; Mostafa Shahein; Juan Manuel Revuelta; Bradley A. Otto; Ricardo L. Carrau; Daniel M. Prevedello

doi:10.1055/s-0038-1623526

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC-BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S237-S238
DOI: 10.1055/s-0038-1623526

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma

Authors

Alexandre B. Todeschini

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
Alaa S. Montaser

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States

²Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
Mostafa Shahein

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
Juan Manuel Revuelta

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States
Bradley A. Otto

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States

³Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center, The Ohio State University, College of Medicine. Columbus, Ohio, United States
Ricardo L. Carrau

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States

³Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center, The Ohio State University, College of Medicine. Columbus, Ohio, United States
Daniel M. Prevedello

¹Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio, United States

³Department of Otolaryngology – Head and Neck Surgery, Wexner Medical Center, The Ohio State University, College of Medicine. Columbus, Ohio, United States

Abstract

We present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible.

Hormonal panel showed no hormonal deficits. The initial diagnosis was of a type II transinfundibular craniopharyngioma (as classified by Kassam et al).

An endoscopic endonasal transplanum transtuberculum approach was done using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. The tumor was carefully dissected away from the optic apparatus while preserving the vessels, mainly the superior hypophyseal artery. The stalk was identified around the tumor and preserved. The third ventricle was entered and inspected at the end of the procedure and a near-total resection (a small residual in the right hypothalamus) with decompression of the optic apparatus was achieved. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap. Patient had an uneventful postoperative stay and was discharged on POD 4, neurologically stable with no hormonal deficits. Pathology confirmed an adamantinomatous craniopharyngioma. Due to a small growth of the residual, patient underwent fractionated stereotactic radiation (50.4Gy in 28 sessions). He presented with panhypopituitarism 2 years after radiation therapy. At 3-month follow-up, his vision was back to normal and 6-year postoperative magnetic resonance imaging showed no signs of recurrence.

The link to the video can be found at: https://youtu.be/chG7XIz7a_A.

Keywords

endoscopic surgery - neurosurgery - skull base - craniopharyngioma

Full Text

References

Reference
1 Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 2008; 108 (04) 715-728