Surgical Nuances of Endoscopic Endonasal Resection of Craniopharyngiomas: 2-Dimensional Operative Video.

Understanding of the microsurgical anatomy of the sella and suprasellar space is necessary for successful selection of surgical approaches and resection of craniopharyngiomas. Endoscopic endonasal surgery provides excellent exposure of the suprasellar space and has become the approach of choice for most of those tumors. In this video, we discuss the anatomical and surgical nuances for resection of craniopharyngiomas via an endoscopic transtuberculum transplanum approach. Anatomical dissections and a clinical case are used to illustrate the technique. This is the case of a 52-yr-old woman who presented to our clinic with a history of progressive visual decline and headaches, but no hormonal deficiencies. Magnetic resonance imaging demonstrated the presence of a sella suprasellar solid cystic lesion suggestive of a craniopharyngioma. The lesion was mainly located anterior to the chiasm, preinfundibular and medial to the posterior-communicating artery. Considering the patient presented with no hormonal deficits, it was decided to proceed with an endoscopic extended approach for maximum tumor resection while attempting to preserve the pituitary stalk and gland and its function. The patient provided consent to undergo the procedure and for the surgical video. After a binostril approach and harvesting of vascularized flap, a large sphenoidotomy was performed, followed by a transtuberculum transplanum approach. The tumor was resected with blunt and sharp dissection with careful preservation of the branches of the superior hypophyseal and posterior-communicating arteries. Closure was performed in a multilayer fashion, with dura substitute, fascia lata, and vascularized flap. The patient had visual improvement after surgery and was discharged at postoperative day 5 with no complications. Anatomical dissection pictures © 2019 Joao Paulo Almeida, MD. Used with permission.

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Copyright © 2019 by the Congress of Neurological Surgeons.