Abstract
Objectives To demonstrate an endoscopic endonasal transplanum transtuberculum approach for the
resection of a large suprasellar craniopharyngioma.
Design Single-case-based operative video.
Setting Tertiary center with dedicated skull base team.
Participants A 72-year-old male patient diagnosed with a suprasellar craniopharyngioma.
Main Outcomes Measured Surgical resection of the tumor and preservation of the normal surrounding neurovascular
structures.
Results A 72-year-old male patient presented with a 1-year history of progressive bitemporal
visual loss. He also referred symptoms suggestive of hypogonadism. Neurological examination
was unremarkable and endocrine workup demonstrated mildly elevated prolactin levels.
Magnetic resonance images demonstrated a large solid-cystic suprasellar lesion, consistent
with the diagnosis of craniopharyngioma. The lesion was retrochiasmatic, compressed
the optic chiasm, and extended into the interpeduncular cistern ([Fig. 1]). Because of that, the patient underwent an endoscopic endonasal transplanum transtuberculum
approach.[1]
[2]
[3] The nasal stage consisted of a transnasal transseptal approach, with complete preservation
of the patient's left nasal cavity.[4] The cystic component of the tumor was decompressed and its solid part was resected.
It was possible to preserve the surrounding normal neurovascular structures ([Fig. 2]). Skull base reconstruction was performed with a dural substitute, a fascia lata
graft, and a right nasoseptal flap ([Video 1]). The patient did well after surgery and referred complete visual improvement. However,
he also presented pan-hypopituitarism on long-term follow-up.
Conclusions The endoscopic endonasal route is a good alternative for the resection of suprasellar
lesions. It permits tumor resection and preservation of the surrounding neurovascular
structures while avoiding external incisions and brain retraction.
The link to the video can be found at: https://youtu.be/zmgxQe8w-JQ.
Keywords
transnasal endoscopic surgery - transnasal endoscopic microsurgery - suprasellar cyst
- craniopharyngioma
