Pear-Shaped Craniopharyngioma: Selection of the Transcranial Approach With Respect to Topographical Classifications

We present the selection of the transcranial microsurgical approach, operative treatment, and outcomes following the resection of a pear-shaped craniopharyngioma (CP). A nine-year-old boy was operated on and followed up for 2.5 years after radical resection of the extrapial CP. Postoperatively, there was no tumor recurrence. The surgical strategy was discussed based on the preoperative MRI appearance of the CP, especially its morphological characteristics, including not only its size and shape but also its relationship with the hypothalamus, pituitary stalk/gland, ventricles, and optic chiasm, and the possible location of perforators. A description of the tumor topography is provided together with a discussion on the rationale for the selection of our surgical approach. Based on an understanding of the tumor topography, important information can be gained for approach selection, surgical planning, and anticipation of the hypothalamic-pituitary outcome.