TY - JOUR
T1 - Endoscopic Endonasal Approach for Resection of a Recurrent Craniopharyngioma
T2 - Techniques to Maximize Surgical Exposure and Extent of Resection
AU - Almeida, Joao Paulo
AU - Marenco-Hillembrand, Lina
AU - Moniz-Garcia, Diogo
AU - Goyal, Anshit
AU - Olomu, Osarenoma U.
AU - Quinones-Hinojosa, Alfredo
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/12
Y1 - 2023/12
N2 - Craniopharyngiomas are challenging tumors of the central nervous system that originate from epithelial remnants of the Rathke pouch.1-3 Despite maximum safe resection, these tumors present a high tendency to recur (∼20%–40%), even after apparent gross total resection.1 2 The management of recurrent craniopharyngiomas is more challenging, associated with a higher risk of permanent morbidity and complications.1 3 The endoscopic endonasal approach is an option for recurrent tumors, especially in the presence of a previous transcranial approach.1 3-7 In Video 1, we present a case of a 63-year-old man with a recurrent craniopharyngioma with a 2-month history of visual decline, confusion, impaired memory, and episodes of urinary incontinence. On physical examination, he presented slow speech, word-finding difficulties, and left homonymous hemianopsia. Magnetic resonance imaging evidenced a large suprasellar, retrochiasmatic mass with solid (calcified) and cystic components with interval progression compared with previous scans. Treatment options were discussed, and the patient consented to undergo maximum safe resection through an extended endoscopic endonasal approach. Surgical techniques are presented side by side with anatomic dissections to illustrate key steps of the procedure. The patient tolerated the procedure well, with gross total resection of the tumor and without complications or postoperative cerebrospinal fluid leaks. He was subsequently discharged home on postoperative day 5 with continued hormonal replacement therapy. On follow-up, the patient presented marked improvement in his cognitive function. The patient gave informed consent for the use of their images.
AB - Craniopharyngiomas are challenging tumors of the central nervous system that originate from epithelial remnants of the Rathke pouch.1-3 Despite maximum safe resection, these tumors present a high tendency to recur (∼20%–40%), even after apparent gross total resection.1 2 The management of recurrent craniopharyngiomas is more challenging, associated with a higher risk of permanent morbidity and complications.1 3 The endoscopic endonasal approach is an option for recurrent tumors, especially in the presence of a previous transcranial approach.1 3-7 In Video 1, we present a case of a 63-year-old man with a recurrent craniopharyngioma with a 2-month history of visual decline, confusion, impaired memory, and episodes of urinary incontinence. On physical examination, he presented slow speech, word-finding difficulties, and left homonymous hemianopsia. Magnetic resonance imaging evidenced a large suprasellar, retrochiasmatic mass with solid (calcified) and cystic components with interval progression compared with previous scans. Treatment options were discussed, and the patient consented to undergo maximum safe resection through an extended endoscopic endonasal approach. Surgical techniques are presented side by side with anatomic dissections to illustrate key steps of the procedure. The patient tolerated the procedure well, with gross total resection of the tumor and without complications or postoperative cerebrospinal fluid leaks. He was subsequently discharged home on postoperative day 5 with continued hormonal replacement therapy. On follow-up, the patient presented marked improvement in his cognitive function. The patient gave informed consent for the use of their images.
KW - Craniopharyngioma
KW - Endoscopic endonasal
KW - Suprasellar tumor
UR - http://www.scopus.com/inward/record.url?scp=85173475713&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85173475713&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2023.07.031
DO - 10.1016/j.wneu.2023.07.031
M3 - Article
C2 - 37454903
AN - SCOPUS:85173475713
SN - 1878-8750
VL - 180
SP - 66
JO - World neurosurgery
JF - World neurosurgery
ER -