TY - JOUR
T1 - The subtemporal approach to retroinfundibular craniopharyngiomas
T2 - A new look at an old approach
AU - Wong, Ricky H.
AU - De Los Reyes, Kenneth
AU - Alikhani, Puya
AU - Sivakanthan, Sananthan
AU - Van Gompel, Jamie
AU - Van Loveren, Harry
AU - Agazzi, Siviero
AU - Friedman, Allan H.
AU - Ammirati, Mario
N1 - Publisher Copyright:
Copyright © 2015 by the Congress of Neurological Surgeons.
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Retrochiasmatic, retroinfundibular craniopharyngiomas are surgically challenging tumors. Anterolateral, posterolateral, and endoscopic endonasal approaches represent the most commonly used techniques to access these tumors, but all require an extensive exposure time, and each has its own risks and limitations. The subtemporal approach is a well-known neurosurgical approach that is rarely described for craniopharyngiomas. OBJECTIVE: To assess the feasibility, advantages, and disadvantages of a subtemporal approach for craniopharyngiomas. METHODS: Five patients with retrochiasmatic craniopharyngiomas where the majority of the tumor extended behind the dorsal clival line underwent a subtemporal approach for resection. Extent of resection, degree of temporal lobe injury, visual and endocrine outcomes, and time to recurrence were analyzed. RESULTS: Average tumor volume was 6.4 cm3. Near-total resection was achieved in 80% (4/5) and subtotal in 20% (1/5). All patients had stable or improved vision. There was 1 new permanent endocrine deficiency. Minimal temporal lobe edema was observed in 80% (4/5) of patients. Three patients required postoperative radiation. CONCLUSION: The subtemporal approach represents a feasible approach for retrochiasmatic, retroinfundibular craniopharyngiomas when gross total resection is not mandatory. It provides rapid access to the tumor and a caudal-to-cranial visualization that promotes minimal manipulation of critical neurovascular structures, particularly the optic apparatus.
AB - BACKGROUND: Retrochiasmatic, retroinfundibular craniopharyngiomas are surgically challenging tumors. Anterolateral, posterolateral, and endoscopic endonasal approaches represent the most commonly used techniques to access these tumors, but all require an extensive exposure time, and each has its own risks and limitations. The subtemporal approach is a well-known neurosurgical approach that is rarely described for craniopharyngiomas. OBJECTIVE: To assess the feasibility, advantages, and disadvantages of a subtemporal approach for craniopharyngiomas. METHODS: Five patients with retrochiasmatic craniopharyngiomas where the majority of the tumor extended behind the dorsal clival line underwent a subtemporal approach for resection. Extent of resection, degree of temporal lobe injury, visual and endocrine outcomes, and time to recurrence were analyzed. RESULTS: Average tumor volume was 6.4 cm3. Near-total resection was achieved in 80% (4/5) and subtotal in 20% (1/5). All patients had stable or improved vision. There was 1 new permanent endocrine deficiency. Minimal temporal lobe edema was observed in 80% (4/5) of patients. Three patients required postoperative radiation. CONCLUSION: The subtemporal approach represents a feasible approach for retrochiasmatic, retroinfundibular craniopharyngiomas when gross total resection is not mandatory. It provides rapid access to the tumor and a caudal-to-cranial visualization that promotes minimal manipulation of critical neurovascular structures, particularly the optic apparatus.
KW - Craniopharyngioma
KW - Retrochiasmatic
KW - Retroinfundibular
KW - Subtemporal approach
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U2 - 10.1227/NEU.0000000000000972
DO - 10.1227/NEU.0000000000000972
M3 - Article
AN - SCOPUS:85008419616
SN - 2332-4252
VL - 11
SP - 495
EP - 503
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 4
ER -