Objective:Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas.Methods:Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors.Results:A gross total or near total excision was achieved in 10 (66.7%) patients, subtotal resection in 4 (26.7%), and partial removal in 1 (6.7%) patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20%) developed postoperative CSF leaks which were managed conservatively. Three (20%) patients with diabetes insipidus and 2 (13.3%) with panhypopituitarism required long-term hormonal replacement therapy.Conclusions:Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks.

Background: Tuberculum sellae (TS) meningiomas are benign lesions that produce neurological deficits through a mass effect on vital neurovascular structures. The treatment of choice is surgical removal with the ultimate goal to improve vision and achieve total tumor removal. Objective: We analyzed clinical features, tumor characteristics, and surgical approaches in 62 consecutive patients with TS meningiomas to identify factors influencing the postoperative outcome. Methods: The authors reviewed the medical records of all patients of TS meningiomas who underwent surgery at our institute between 2005 and 2018. Pre- and postoperative clinical data, including the operative findings, of these patients were analyzed. Results: Sixty-two patients who underwent surgery for removal of TSM, transcranial (TCA) in 38, and endoscopic endonasal (EEA) in 24, were identified. Gross total resection was performed in 84% and 87.5% patients in the TCA and EEA groups, respectively. A significantly higher rate of visual improvement was observed in the EEA group as compared to TCA (96% versus 79%). Visual worsening after surgery was greater with TCA than EEA (21% versus 4%). Fourteen (37%) patients in the TCA group experienced different postoperative complications, and CSF leak was the main complication in the EEA group. Conclusions: TCA and EEA are both associated with higher rates of GTR and visual improvement without compromising the safety of the procedure. An optimal outcome, however, depends on the careful selection of cases based on the tumor location and morphology, and the surgeon's familiarity with the surgical approach.

In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.

Our early experience suggests that the EEEA offers a potentially viable treatment option in certain pituitary tumors which are difficult to remove by the standard endoscopic approaches. However, longer follow-up and larger series are needed to establish the efficacy of this approach.

The surgical treatment of craniopharyngiomas is challenging. An optimal surgical approach is extremely important to achieve complete removal of the tumor, which is often the goal of treatment. Conventionally, the endoscopic transsphenoidal approach is used for resection of craniopharyngiomas that are essentially confined to the sellar cavity, or have smaller suprasellar extension. However, the tumors located in the retrochiasmatic space are difficult to remove surgically due to a poor access. Traditionally, various transcranial microsurgical routes have been employed with limited success for resection of retrochiasmatic craniopharyngiomas. The transcranial approaches generally do not provide adequate exposure of the tumors originating in the space under the optic chiasm and nerves. Recently, the extended endonasal endoscopic surgical route, obtained by removal of the tuberculum sellae and planum sphenoidale, has been used with great success in the surgical management of tumors lying ventral to the optic chiasm, including craniopharyngiomas. It offers a direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. It also allows extracapsular dissection using binostril-bimanual technique and facilitates complete removal of these formidable tumors. In this report, we describe step-by-step, the technical details of the endonasal endoscopic transplanum transtuberculum approach with emphasis on the operative nuances for removal of retrochiasmatic craniopharyngiomas.