Transcavernous Sinus Transtuber Cinereum Approach for Pure Third Ventricle Craniopharyngioma Resection

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Neuro-oncology

Background:

• Intraventricular craniopharyngiomas pose significant surgical challenges due to their location near vital neurovascular structures.
• The transcavernous sinus transtuber cinereum (TCSTC) approach is a specialized technique designed for accessing the third ventricle.

Purpose of the Study:

• To evaluate the safety and efficacy of the TCSTC approach for resecting pure intraventricular craniopharyngiomas.
• To assess the anatomical feasibility and clinical outcomes of this surgical corridor.

Main Methods:

• Cadaveric dissection of 10 heads with vascular injection to define the safe entry zone and anatomical corridor.
• Clinical application in 5 patients with intraventricular craniopharyngiomas using a pretemporal craniotomy and partial medial transcavernous approach.
• Review of surgical outcomes, complications, and long-term follow-up.

Main Results:

• Cadaveric dissections confirmed a consistent and safe entry corridor (mean width 8.2 mm) to the third ventricle.
• Gross total tumor resection was achieved in all 5 clinical cases without intraoperative complications.
• Postoperative outcomes included transient diabetes insipidus (2 patients) and long-term hormone replacement (3 patients); no CSF leaks or infections occurred.

Conclusions:

• The TCSTC approach is a safe and effective strategy for pure intraventricular craniopharyngiomas.
• It provides enhanced visualization and minimizes hypothalamic and vascular injury.
• Maximal tumor removal with low morbidity is achievable with proper technique.