Preservation of the Olfactory Tract in Bifrontal Craniotomy

Management of craniopharyngiomas

“…Surgical treatment with craniotomy (figures 2a, 2b) has been the standard for many years 1,7,14,15,17,18,23,24,38,40,44,50,51 . It is indicated for suprasellar tumors and allows for visualization of the optic nerves, the optic chiasm, and the relationship of the tumor to these structures and the carotid arteries and the IIIrd cranial nerve.…”

“…Exclusively small intraventricular lesions can be reached through the lamina terminalis or transventricular (trans-callosal or the transventricular approaches). The main types of approaches for big tumors are pterional, subfrontal transbasal 2,48 , extended pterional, bifrontal, orbitozygomatic 1,23,48,49 , temporopolar 45 , fronto orbitozygomatic 11 , modified osteoplastic frontoorbitozygomatic craniotomy for children 34 , fronto orbitozygomatic temporopolar 31 . For giant tumors, combined skull base approaches may be useful, taking in consideration the position in relation to optic chiasm (retrochiasmatic, chiasmatic, prechiasmatic).…”

“…Access is obtained through the optic chiasmatic cistern and both carotid optic cisterns. After shrinking the capsule with bipolar or draining the cyst , dissection is performed in the outer limits of capsule : the tumor is taken in piece meal or it is removed "en bloc " by gentle traction 1 .…”