Endoscopic Endonasal Approach in Craniopharyngiomas: Representative Cases and Technical Nuances for the Young Neurosurgeon
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Endoscopic Endonasal Approach
3.1.1. Nasal Phase
3.1.2. Sphenoidal Phase
3.1.3. Sellar Phase
3.1.4. Closure
3.2. Representative Clinical Cases
3.2.1. Case 1
3.2.2. Case 2
3.2.3. Case 3
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Modified Level of Complexity in Endoscopic Endonasal Surgery | ||
---|---|---|
Level | Compartment | Pathology |
I | Extradural | CSF leak Chordoma Carcinoma |
II | Pituitary fossa | Pituitary adenoma Craniopharyngioma |
III | Anterior skull base floor | Meningioma Esthesioneuroblastoma Fibrous displasia |
IV | Orbit Pterygo-pallatine fossa Maxillary sinus | Trigeminal Schwannoma |
V | Cisterns Interpeduncular fossa Clivus | Craniopharyngioma Chordoma Pituitary adenoma |
VI | Cavernous sinus | Pituitary adenoma Hemangioblastoma Meningioma |
VII | Vascular | Paraclinoid aneurysm ACo aneurysm Basilar aneurysm Vertebral aneurysm |
VIII | Intrinsic | Cavernoma Metastasis Glioma |
Categories of Technical Complexity and Surgical Expertise of Endoscopic Endonasal Approaches for Craniopharyngiomas | ||
---|---|---|
Category | Tumor Location/ Extension | Technical Nuances |
A | Intrasellar/infradiaphragmatic | Anatomic relationships similar to that of pituitary adenomas. The sellar floor is enlarged providing enough space for resection and, thus, facilitating the approach. |
B | Intra-suprasellar/infradiaphragmatic | Neurovascular structures in the suprasellar side of the tumor protected by the diaphragm. Sufficient space between pituitary gland and the optic chiasm for tumor resection. |
C | Suprasellar/preinfundibular or transinfundibular | An extended endoscopic endonasal approach is required. Size of the sella is often normal or reduced, resulting in a narrower approach due to closeness of the two intracavernous carotids. Arteries of the circle of Willis are often displaced by the suprasellar mass. |
D | Suprasellar/retroinfundibular | Requires a more posterior approach. Stretch relationship with important neurovascular structures such as the mammillary bodies and basilar apex. Requires a pituitary transposition, increasing the technical complexity of the approach. |
E | Arising or extending into the third ventricle | Risk of injury to the hypothalamus, brainstem, and other important neurovascular structures. Increased risk for CSF fistula due to communication of the ventricular cavity with the sphenoid sinus. |
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Aragón-Arreola, J.F.; Marian-Magaña, R.; Villalobos-Diaz, R.; López-Valencia, G.; Jimenez-Molina, T.M.; Moncada-Habib, J.T.; Sangrador-Deitos, M.V.; Gómez-Amador, J.L. Endoscopic Endonasal Approach in Craniopharyngiomas: Representative Cases and Technical Nuances for the Young Neurosurgeon. Brain Sci. 2023, 13, 735. https://doi.org/10.3390/brainsci13050735
Aragón-Arreola JF, Marian-Magaña R, Villalobos-Diaz R, López-Valencia G, Jimenez-Molina TM, Moncada-Habib JT, Sangrador-Deitos MV, Gómez-Amador JL. Endoscopic Endonasal Approach in Craniopharyngiomas: Representative Cases and Technical Nuances for the Young Neurosurgeon. Brain Sciences. 2023; 13(5):735. https://doi.org/10.3390/brainsci13050735
Chicago/Turabian StyleAragón-Arreola, Jorge F., Ricardo Marian-Magaña, Rodolfo Villalobos-Diaz, Germán López-Valencia, Tania M. Jimenez-Molina, J. Tomás Moncada-Habib, Marcos V. Sangrador-Deitos, and Juan L. Gómez-Amador. 2023. "Endoscopic Endonasal Approach in Craniopharyngiomas: Representative Cases and Technical Nuances for the Young Neurosurgeon" Brain Sciences 13, no. 5: 735. https://doi.org/10.3390/brainsci13050735
APA StyleAragón-Arreola, J. F., Marian-Magaña, R., Villalobos-Diaz, R., López-Valencia, G., Jimenez-Molina, T. M., Moncada-Habib, J. T., Sangrador-Deitos, M. V., & Gómez-Amador, J. L. (2023). Endoscopic Endonasal Approach in Craniopharyngiomas: Representative Cases and Technical Nuances for the Young Neurosurgeon. Brain Sciences, 13(5), 735. https://doi.org/10.3390/brainsci13050735