Interhemispheric Transcallosal Transforaminal Approach and Microscopic Third Ventriculostomy for Intraventricular Craniopharyngioma Associated with Asymmetric Hydrocephalus: Case Report and Literature Review

Abstract

We report on a case of a solid adamantinomatous variant of craniopharyngioma located entirely within the third ventricle causing asymmetric obstructive hydrocephalus in a 43-year-old male patient. The patient complaints included intermittent severe headache and progressive bilateral visual field loss. Initially, the lesion was accessed via the bifrontal interhemispheric translamina terminalis approach but total removal was not possible due to short anterior communicating artery which limited the exposure. In the second stage, we used the right interhemispheric transcallosal transforaminal approach and achieved total tumor removal followed by microscopic third ventriculostomy. The present article discusses the selection of appropriate surgical approach based on concise literature review that provides favorable surgical management of these rare lesions.

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

“…The trans-lamina terminalis approach was first described by ( 47 ) in 1936 for the treatment of tumor-related hydrocephalus ( 24 ). The lamina terminalis is accessible via an anterior interhemispheric approach or a sub-frontal corridor or via a more lateral corridor through a pterional craniotomy ( 4 , 9 , 18 , 24 , 48 ). During the pterional (fronto-temporal) approach, due to the angulation of the surgical trajectory, it may be difficult to visualize the posterior-most region of the third ventricle.…”

“…It is ideal for tumors located predominantly in the inferior part of the third ventricle. It is, however, not suitable for large lesions, for which a transventricular approach is more appropriate ( 4 , 5 , 9 , 12 , 16 , 51 , 52 ). The risks associated with the translamina terminalis approach include a retraction injury or perforator damage involving the optic pathway, columns of fornix, supraoptic nuclei, organum vasculosum, and tuber cinereum ( 5 , 9 , 53 ).…”

“…Craniopharyngiomas are benign tumors, originating either from squamous epithelial cell that rests in the Rathke's pouch, located along its path from the nasopharynx to the infundibulum, or as a result of squamous metaplasia from the pars tuberalis of the pituitary gland (1)(2)(3)(4). They constitute 2-4% of all intracranial tumors (3,(5)(6)(7)(8)(9)(10)(11)(12). Multiple classification systems (based on their imaging features) have been proposed to help in choosing the appropriate management strategy (13).…”

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“…The trans-lamina terminalis approach was first described by (47) in 1936 for the treatment of tumor-related hydrocephalus (24). The lamina terminalis is accessible via an anterior interhemispheric approach or a sub-frontal corridor or via a more lateral corridor through a pterional craniotomy (4,9,18,24,48). During the pterional (fronto-temporal) approach, due to the angulation of the surgical trajectory, it may be difficult to visualize the posterior-most region of the third ventricle.…”