REVIEW  THE LIMITS OF ENDOSCOPIC ENDONASAL APPROACHES 

Journal of Neurosurgical Sciences 2018 June;62(3):310-21

DOI: 10.23736/S0390-5616.18.04331-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Limits of endoscopic endonasal surgery for III ventricle craniopharyngiomas

Douglas A. HARDESTY ^{1, 2}, Alaa S. MONTASER ^{1, 3}, André BEER-FURLAN ^{1, 4}, Ricardo L. CARRAU ^{1, 5}, Daniel M. PREVEDELLO ^{1, 5} ✉

¹ Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA; ² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; ³ Department of Neurosurgery, Ain Shams University, Cairo, Egypt; ⁴ Department of Neurosurgery, Rush University, Chicago, IL, USA; ⁵ Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA

Craniopharyngiomas represent one of the most challenging brain tumors for the neurosurgeon. For most of the 20th century, these parasellar lesions have been approached via the classic open approaches of neurosurgery such as pterional, frontobasal, interhemispheric, and transpetrosal craniotomies. The endoscopic endonasal approach to these tumors, rather than craniotomy, has risen in popularity over the last two decades. Regardless of approach, a detailed knowledge of surgical anatomy and careful preoperative surgical planning are essential to achieve good clinical results; iatrogenic morbidity can potentially be severe due to hypothalamus, optic apparatus, and/or vascular injuries. Especially challenging, and highlighting the limitations of endoscopic endonasal surgery, are the tumors that arise primarily from within the third ventricle and do not expand the pituitary stalk and suprasellar region or tumors that have projected to areas far from the parasellar region as such as the sylvian and ambient cisterns. Herein we review the published literature regarding endoscopic endonasal surgery for craniopharyngioma, and the anatomical and functional limitations therein. The benefits and drawbacks of each surgical approach to this deep-seated area are discussed, and a strategy for surgical decision-making proposed.

KEY WORDS: Skull base - Surgery - Neurosurgical procedures - Endoscopy - Methods