The subtemporal approach to retroinfundibular craniopharyngiomas: A new look at an old approach

Ricky H. Wong, Kenneth De Los Reyes, Puya Alikhani, Sananthan Sivakanthan, Jamie Van Gompel, Harry Van Loveren, Siviero Agazzi, Allan H. Friedman, Mario Ammirati

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)495-503
Number of pages9
JournalOperative Neurosurgery
Volume11
Issue number4
DOIs
StatePublished - 2015

Keywords

  • Craniopharyngioma
  • Retrochiasmatic
  • Retroinfundibular
  • Subtemporal approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Wong, R. H., De Los Reyes, K., Alikhani, P., Sivakanthan, S., Van Gompel, J., Van Loveren, H., Agazzi, S., Friedman, A. H., & Ammirati, M. (2015). The subtemporal approach to retroinfundibular craniopharyngiomas: A new look at an old approach. Operative Neurosurgery, 11(4), 495-503. https://doi.org/10.1227/NEU.0000000000000972