Subpial dissection technique in endoscopic endonasal surgery for craniopharyngiomas with supradiaphragmatic extension

Craniopharyngioma surgery requires balancing maximal resection with functional preservation, particularly in supradiaphragmatic tumors. We demonstrate a subpial dissection technique during an endoscopic endonasal approach for a transinfundibular-to-retroinfundibular craniopharyngioma in a 4-year-old girl. Based on the concept that the tumor surface is circumferentially covered by a continuous pial layer extending from the pituitary stalk, dissection was performed within the subpial plane to achieve radical tumor removal while maximizing preservation of hypothalamic and pituitary function. This technique avoids direct manipulation of critical neurovascular structures, facilitates preservation of the endocrine function, and can be applied across various growth patterns of suprasellar craniopharyngiomas. The video can be found here: https://stream.cadmore.media/r10.3171/2026.7.FOCVID2685.