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CC-BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S245-S246
DOI: 10.1055/s-0038-1626707
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Approach for Resection of a Pediatric Craniopharyngioma: Operative Video and Technical Nuances

James K. Liu
1   Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
2   Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
3   Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
,
Jean Anderson Eloy
1   Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
2   Department of Otolaryngology-Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
3   Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
4   Department of Ophthalmology and Visual Science, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States
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Address for correspondence

James K. Liu, MD
Department of Neurological Surgery, Rutgers University, New Jersey Medical School
90 Bergen Street, Suite 8100
Newark, New Jersey 07103
United States   

Publication History

24 December 2017

02 January 2018

Publication Date:
26 February 2018 (online)

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Abstract

We present a pediatric case of a retrochiasmatic craniopharyngioma in the suprasellar region with third ventricular extension that was resected through a purely endoscopic endonasal approach (EEA) via the transplanum transtuberculum corridor. The patient is a 12-year-old boy who presented with progressive visual loss and panhypopituitarism. The EEA allows direct visualization of the undersurface of the optic chiasm and hypothalamus so that safe and meticulous tumor dissection can be performed to preserve these critical neurovascular structures. This video atlas demonstrates the operative technique and surgical nuances of the endoscopic skull base approach, microdissection of the tumor from the critical neurovascular structures, and multilayered reconstruction of the skull base defect with a nasoseptal flap. A gross total resection was achieved, and the patient was neurologically intact with improved visual acuity and visual fields. In summary, the EEA via the transplanum transtuberculum corridor is an important strategy in the armamentarium for surgical management of pediatric craniopharyngiomas.

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


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Keywords

endoscopic endonasal approach - craniopharyngioma - pediatric skull base surgery - suprasellar tumor
Zoom Image
Fig. 1 Preoperative (A: sagittal, B: coronal) and postoperative (C: sagittal, D: coronal) postgadolinium T1-weighted MRI of a retrochiasmatic craniopharyngioma removed via an endoscopic endonasal approach. Gross total resection was achieved. MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 (A) Intraoperative endoscopic view of the tumor (T) being dissected from the undersurface of the optic chiasm (OC) and left optic nerve (ON). (B) View of the resection bed after total removal of the tumor. 3V, third ventricle; CA, cerebral aqueduct; Hyp, hypothalamus.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


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

Address for correspondence

James K. Liu, MD
Department of Neurological Surgery, Rutgers University, New Jersey Medical School
90 Bergen Street, Suite 8100
Newark, New Jersey 07103
United States   

   Permissions and Reprints
Zoom Image
Fig. 1 Preoperative (A: sagittal, B: coronal) and postoperative (C: sagittal, D: coronal) postgadolinium T1-weighted MRI of a retrochiasmatic craniopharyngioma removed via an endoscopic endonasal approach. Gross total resection was achieved. MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 (A) Intraoperative endoscopic view of the tumor (T) being dissected from the undersurface of the optic chiasm (OC) and left optic nerve (ON). (B) View of the resection bed after total removal of the tumor. 3V, third ventricle; CA, cerebral aqueduct; Hyp, hypothalamus.