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Home  Pterional Craniotomy c Total Removal of Craniopharyngioma
Pterional Craniotomy c Total Removal of Craniopharyngioma
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Prof. Jonghee Chang Severance Hospital | Republic of Korea Speciality : Neurosurgery
10:13

Published : 2016-12-05  Views : 1,246 Likes :
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Information

Summary
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


Patient
Gender
Female

Age
25

Diagnosis
Craniopharyngioma

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


■ Microscope : CarlZeiss Pentero 900

■ Navigation : Medtronic

■ Surgical Drill :    -

■ 3D Camera : 3DMedivision M-Flix

■ 3D Recorder : 3DMedivision R-Flix

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