Transsphenoidal microsurgery for craniopharyngioma

Honegger, Jürgen; Buchfelder, Michael; Fahlbusch, Rudolf; Däubler, Bernd; Dörr, H. G.

doi:10.1016/0090-3019(92)90229-g

Cited by 117 publications

(80 citation statements)

References 10 publications

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“…The effectiveness of this technique for the treatment of such craniopharyngiomas has been confirmed throughout the years by several publications. 28,41,46,66,67,75 This route represented the shortest corridor through which to approach these lesions, and over time it has improved with the introduction of several tools The treatment of craniopharyngiomas via the endoscopic endonasal approach was first reported by Jho and colleagues, [47][48][49] and was later defined and popularized by Kassam and the Pittsburgh group. 55 The extended variations of the procedure offer an inverse view of the surgical field as compared with the transcranial, permitting the removal of supradiaphragmatic craniopharyngiomas with a direct and median orientation, reducing manipulation of the optic apparatus and brain retraction.…”

Section: Discussionmentioning

confidence: 99%

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Cavallo

Günther

Cappabianca

et al. 2014

JNS

190

198

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Object Despite their benign histological appearance, craniopharyngiomas can be considered a challenge for the neurosurgeon and a possible source of poor prognosis for the patient. With the widespread use of the endoscope in endonasal surgery, this route has been proposed over the past decade as an alternative technique for the removal of craniopharyngiomas. Methods The authors retrospectively analyzed data from a series of 103 patients who underwent the endoscopic endonasal approach at two institutions (Division of Neurosurgery of the Università degli Studi di Napoli Federico II, Naples, Italy, and Division of Neurosurgery of the Bellaria Hospital, Bologna, Italy), between January 1997 and December 2012, for the removal of infra- and/or supradiaphragmatic craniopharyngiomas. Twenty-nine patients (28.2%) had previously been surgically treated. Results The authors achieved overall gross-total removal in 68.9% of the cases: 78.9% in purely infradiaphragmatic lesions and 66.3% in lesions involving the supradiaphragmatic space. Among lesions previously treated surgically, the gross-total removal rate was 62.1%. The overall improvement rate in visual disturbances was 74.7%, whereas worsening occurred in 2.5%. No new postoperative defect was noted. Worsening of the anterior pituitary function was reported in 46.2% of patients overall, and there were 38 new cases (48.1% of 79) of postoperative diabetes insipidus. The most common complication was postoperative CSF leakage; the overall rate was 14.6%, and it diminished to 4% in the last 25 procedures, thanks to improvement in reconstruction techniques. The mortality rate was 1.9%, with a mean follow-up duration of 48 months (range 3–246 months). Conclusions The endoscopic endonasal approach has become a valid surgical technique for the management of craniopharyngiomas. It provides an excellent corridor to infra- and supradiaphragmatic midline craniopharyngiomas, including the management of lesions extending into the third ventricle chamber. Even though indications for this approach are rigorously lesion based, the data in this study confirm its effectiveness in a large patient series.

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Section: Discussionmentioning

confidence: 99%

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Cavallo

Günther

Cappabianca

et al. 2014

JNS

190

198

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“…69,70,100 Other surgery-related complications include postoperative drowsiness and a persistent confusional state associated with the transtemporal approach, 125 fusiform dilation of the internal carotid artery, 124 fatal intraoperative internal carotid artery rupture associated with transsphenoidal resection, 67 rhinorrhea or meningitis after drilling of the tuberculum sellae, or transsphenoidal surgery. 52,54 Ectopic craniopharyngioma has been…”

Section: Craniopharyngioma Of the Middle Cranial Basementioning

confidence: 99%

Tumors of the skull base in children: review of tumor types and management strategies

Tsai¹,

Santoreneos²,

Rutka³

2002

FOC

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Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

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“…19,20,24,44,47,54 Alternatively, the transnasal route via the extended transsphenoidal (microsurgical) approach offers a direct trajectory to the sellar and suprasellar space for strictly midline tumors. 13,29,40,41 More recently in the last decade, the purely extended endoscopic endonasal approach (EEA) via the transplanum transtuberculum corridor has become a useful and effective route for removing craniopharyngiomas in the retrochiasmatic space extending superiorly into the third ventricle. 5,[7][8][9][10]22,23,31,33,[35][36][37]42,45 Lastly, purely intraventricular craniopharyngiomas situated in the third ventricle and/or lateral ventricles may be better accessed with transcortical or transcallosal intraventricular approaches.…”

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confidence: 99%

Microscopic versus endoscopic approaches for craniopharyngiomas: choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach

Liu

Sevak

Carmel

et al. 2016

FOC

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Resection remains the mainstay of treatment for craniopharyngiomas with the goal of radical resection, if safely possible, to minimize the rate of recurrence. Endoscopic endonasal and microscopic transcranial surgical approaches have both become standard methods for the treatment for craniopharyngiomas. However, the approach selection paradigm for craniopharyngiomas is still a point of discussion. Choosing the optimal surgical approach can play a significant role in maximizing the extent of resection and surgical outcome while minimizing the risks of potential complications. Craniopharyngiomas can present with a variety of different sizes, locations, and tumor consistencies, and each individual tumor has distinct features that favor one specific approach over another. The authors review standard cranial base techniques applied to craniopharyngioma surgery, using both the endoscopic endonasal approach and traditional open microsurgical approaches, and analyze factors involved in approach selection. They discuss their philosophy of approach selection based on the location and extent of the tumor on preoperative imaging as well as the advantages and limitations of each surgical corridor, and they describe the operative nuances of each technique, using a personalized, tailored approach to the individual patient with illustrative cases and videos.

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Transsphenoidal microsurgery for craniopharyngioma

Cited by 117 publications

References 10 publications

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Tumors of the skull base in children: review of tumor types and management strategies

Microscopic versus endoscopic approaches for craniopharyngiomas: choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach

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