Removal of craniopharyngioma by subnasal-transsphenoidal operation

Two children with transsphenoidal microneurosurgical extirpation of a craniopharyngioma are presented. The value of this relatively new surgical approach is demonstrated, and the indication for transsphenoidal microsurgery in selected cases of craniopharyngioma is discussed in relation to the hitherto few similar case reports in the pertinent literature. The subnasal-transsphenoidal approach is the operative method of choice in purely or mainly intrasellar craniopharyngioma. This operation is also indicated in combined intra- and suprasellar craniopharyngiomas where the solid portion of the tumor is located intrasellarly and where the cystic part extends suprasellarly. In addition, the transsphenoidal operation may be a safe procedure in emergency cases with rapid loss of vision provided that the craniopharyngioma does not have a purely supra- and parasellar expansion. The esseential prerequisite for transsphenoidal neurosurgery in craniopharyngioma is an enlarged sella turcica. The importance of computerized cranial tomography with regard to preoperative differential diagnosis of a predominantly solid or cystic lesion and to postoperative control of radical tumor excision is emphasized. It is assumed that 25% of all patients with craniopharyngioma could benefit from transsphenoidal operation.