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Customized ventral bony and dural opening in the transplanum/transtuberculum and transclival variants of extended endoscopic endonasal approach to suprasellar craniopharyngiomas: an approach-based stepwise cadaveric dissection and clinical applicability

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Abstract

Background

Optimal initial exposure through an extended endoscopic endonasal approach (EEA) for suprasellar craniopharyngiomas ensures safe and unrestricted surgical access while avoiding overexposure, which may prolong the procedure and increase neurovascular adverse events.

Method

Here, the authors outline the surgical nuances of a customized bony and dural opening through the transplanum/transtuberculum and transclival variants of the extended EEA to suprasellar craniopharyngiomas based on the tumor–pituitary stalk relationship. A stepwise cadaveric dissection and intraoperative photographs relevant to the approaches are also provided.

Conclusion

Safe maximal resection of suprasellar craniopharyngiomas through extended EEAs can be feasibly and safely achieved by implementing of tailored ventral exposure.

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Data availability

Not applicable.

Code availability

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Abbreviations

EEA:

Endoscopic endonasal approach

ICA:

Internal carotid artery

MOCR:

Medial opticocarotid recess

PCP:

Posterior clinoid process

SIS:

Superior intercavernous sinus

NSF:

Nasoseptal flap

CSF:

Cerebrospinal fluid

References

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Mehdi Khaleghi & Daniel M. Prevedello

  2. Department of Otolaryngology-Head & Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Bradly Otto, Ricardo Carrau & Moataz D. Abouammo

Authors
  1. Mehdi Khaleghi
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  2. Bradly Otto
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  3. Ricardo Carrau
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  4. Daniel M. Prevedello
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  5. Moataz D. Abouammo
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Contributions

Writing, original draft, conceptualization, visualization, and software, MK; review and editing, DP; validation and supervision, BO, RC, and DP, MDA visualization.

Corresponding author

Correspondence to Daniel M. Prevedello.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

The patient consented to participate.

Consent for publication

The patient consented for publication.

Conflict of interest

Dr. Daniel Prevedello is a consultant for Stryker Corp., Medtronic Corp., BK Medical, and Integra; he has received an honorarium from Mizuho and royalties from KLS-Martin and ACE Medical. All other authors do not have a conflict of interest to report.

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Key points

1. The extended EEA provides excellent access to the midline structures, spanning from the foramen magnum to the cribriform plate.

2. Two main advantages of EEA for suprasellar craniopharyngioma are achieving the optimal extent of resection and minimizing neurovascular manipulation.

3. Complete drilling of the tubercular recess and MOCRs is necessary to freely access the suprasellar cistern.

4. Exposing the opticocarotid cistern is a key to land on the epicenter of the preinfundibular CPs.

5. The division of the SIS is required in all types of suprasellar CPs.

6. An intradural pituitary hemitransposition and removal of dorsum sellae provides wide access to retroinfundibular CP.

7. Unilateral pituitary hemitransposition may preserve the gland’s function by establishing its venous return.

8. Intraoperative ultrasound could estimate subarachnoid tumor extension before dural opening.

9. Gross total tumor removal should be set as the main surgical goal whenever possible.

10. Safe subtotal resection followed by adjuvant therapy provides long-term outcomes similar to total resection.

The original version of this article was revised. The correct author group should be Mehdi Khaleghi, Bradly Otto, Ricardo Carrau, Daniel M. Prevedello, Moataz D. Abouammo and not Mehdi Khaleghi, Bradly Otto, Ricardo Carrau, Daniel M. Prevedello.

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Khaleghi, M., Otto, B., Carrau, R. et al. Customized ventral bony and dural opening in the transplanum/transtuberculum and transclival variants of extended endoscopic endonasal approach to suprasellar craniopharyngiomas: an approach-based stepwise cadaveric dissection and clinical applicability. Acta Neurochir 166, 146 (2024). https://doi.org/10.1007/s00701-024-06015-z

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