Frontobasal interhemispheric approach for large superasellar craniopharyngiomas: do the benefits outweigh the risks?

Large suprasellar craniopharyngiomas are surgically challenging. The aim of our study was to explore the therapeutic efficacy of the frontobasal interhemispheric approach for these lesions.

Twenty-nine consecutive adult patients with large suprasellar craniopharyngiomas (diameter >4 cm) who underwent the frontobasal interhemispheric approach were retrospectively evaluated. Surgical and clinical outcomes were analyzed.

Gross total removal was achieved in 23 cases (79.3%) and subtotal removal in 6 cases (20.7%). The mean follow-up period was 76.5 ± 33.2 months (range, 12-132 months). Twenty-four patients (82.7%) had improvement of the visual impairment score (VIS) after surgery. VIS was unchanged in five patients (17.3%), and no patients experienced visual deterioration. Among 23 patients who had preoperative hypopituitarism, 8 (34.8%) had an improvement. Postoperative new or aggravated hypopituitarism was observed in four patients (13.8%). Permanent diabetes insipidus was observed in ten patients (34.4%). Postoperative anosmia occurred in two earlier cases (6.9%). There was no intracranial infection or cerebrospinal fluid fistula. At last follow-up, >9% BMI gain was observed in 34.5% of patients, and 65.5% of patients returned to work. Four patients (13.8%) suffered recurrence.

Although the frontobasal interhemispheric approach has some disadvantages, it provides ideal access to the suprasellar region and the third ventricle with limited brain retraction. The surgically visible angle is adequate; thus, vital structures can be better protected. For large suprasellar craniopharyngiomas, the benefits of this approach can outweigh its potential risks.