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Pterional Craniotomy c̅ Total Removal of Craniopharyngioma

Prof. Jonghee Chang Severance Hospital | Republic of Korea Speciality : Neurosurgery

10:13

Information

Related Information
Tumors such as pituitary tumors, craniopharyngiomas, midline meningiomas, or a Rathke cleft cyst causing symptoms from mass effect (vision loss, pituitary or hypothalamic dysfunction) all require surgical decompression and/or resection.

This surgery aimes at removing the craniopharyngioma which shall help in decreasing the disabling signs and symptoms. Craniotomy is common and traditional procedure to access the tumor and remove as much tumor as possible and safe.

A determining factor in the approach
- Size of sella
- Degree of its minerallisation
- Pneumatisation of the sphenoid sinus
- Position and tortuisity of carotid arteries
- Presence / directions of intracranial extensions
- Uncertainty about pathology of tumor
- Prior therapy

Type of Approach
Standard Transsphenoidal approach
- Endonasal submucosal transseptal transsphenoidal approach
- Endonasal submucosal septal pushover approach
- Sublabial transseptal transsphenoidal approach
- Endoscopic transsphenoidal approach

Standard Transcranial approach
- Pterional craniotomy
- Subfrontal craniotomy
- Subtemporal craniotomy

Alternative Skull Base approach
- Frontal-Orbital-Zygomatic osteotomy approach
- Transbasal approach of Derome
- Extended Transsphenoidal approach

Lateral Rhinotomy or Paranasal approach
- Sublabial transseptal approach with nasomaxillary osteotomy
- Transethomodal and extended transethmoidal approaches
- Sublabial transantral approach

Pterional approach

Indications
- Hemorrhage into and existing tumor
- Acute necrosis of the tumor and subsequent swelling
- Sudden headache, precipitous visual loss, ophthalmoplegia, altered consciousness,
acute adrenal insuffiency & collapse
- Urgent glucocorticoid replacement and surgical decompression
- Subclinical apeplexy (microhemorrhage / infarction without clinically devastating result)
- Analgesia, hormone replacement
- Hyperfunctioning pituitary adenomas
- Failure to prior treatment
- Recurrent symptoms after radiotherapy
- Inadequate response following pharmacotherapy

Contraindication
- Florid Cushing’s disease, acromegaly or secondary hyperthyroidism
- Profound hypopituitalism
- Active sinus infection
- Ectatic / tortous carotic arteries

Sex
Female

Age
25

Chief Complaint
- Visual disturbance
- Headache
- Inferonasal quadranopsia
- OD: Temporal hemianopsia
- OS: Decreased visual acuity

Medical Devices

■ Microscope : CarlZeiss Pentero 900

■ Navigation : Medtronic

■ Surgical Drill : N/A

■ 3D Camera : 3DMedivision M-Flix

■ 3D Recorder : 3DMedivision R-Flix

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