Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery
• Neuro-oncology

Background:

• Craniopharyngiomas are tumors often located in the suprasellar region, posing surgical challenges due to proximity to critical neurovascular structures.
• Traditional open approaches may involve significant brain retraction, leading to potential complications.
• The extended endoscopic endonasal approach (EEEA) has emerged as a less invasive alternative for accessing skull base pathologies.

Purpose of the Study:

• To illustrate the application of the extended endoscopic endonasal approach (EEEA) for the treatment of a suprasellar craniopharyngioma.
• To demonstrate the surgical technique, outcomes, and feasibility of EEEA in managing complex skull base tumors.

Main Methods:

• A case report detailing the surgical management of a 43-year-old male with a large suprasellar craniopharyngioma involving the third ventricle.
• The extended endoscopic endonasal approach (EEEA) was utilized, featuring a bilateral parasagittal technique with a Hadad's flap and extension to the planum sphenoidalis.
• Complete tumor resection was achieved using an ultrasound aspirator, followed by a three-layer skull base reconstruction.

Main Results:

• The patient experienced no postoperative complications and demonstrated an improvement in neurological status, although panhypopituitarism developed.
• Postoperative imaging at one year confirmed complete absence of pathological contrast enhancement, indicating successful tumor removal.
• Visual deficits remained stable, and the EEEA provided optimal visualization with no brain retraction.

Conclusions:

• The extended endoscopic endonasal approach (EEEA) is a feasible and effective surgical option for treating craniopharyngiomas with suprasellar extension.
• EEEA offers advantages such as excellent visualization, high resection rates, and avoidance of brain retraction, leading to favorable patient outcomes.
• This minimally invasive technique represents a valuable advancement in the surgical management of complex suprasellar tumors.