Shamsul Alam, Abu Naim Wakil Uddin, Mashiur Rahman Majumder, Abu Saleh Mohammad Abu Obaida, Saif Ul Haque, Narendra Shalike, Kamrunnessa Hossain
Extended endonasal endoscopic approach for the non-pituitary lesions of the sellar and suprasellar regions are not new in the field of neurosurgery. Traditional transsphenoidal approach gives exposure to the pituitary fossa, whereas extended approach provides exposure to the optic nerve, chiasm, A-com complex, basal frontal lobe, mammillary body, midbrain, 3rd cranial nerve, basilar artery, Circle of Willis and laterally to the cavernous sinuses.
Methods and Materials:
From November 2007 to February 2016,there were 40 cases of craniopharyngiomaoperated by the extended endonasalendoscopic approach. Patientâ€™s history, clinical findings, pre-operative &post-operative visual acuity, visual field analysis and radiological data were collected and analyzed.
Age group of the patients varied from 10 to 60 yrs. Male were 19 (47.5%), female were 21 (52.5%).Gross total removal was achieved in 22 cases (55.0%) and subtotal in 10 (25.0%) cases. Visual acuity and visual field improved in all cases. One case (2.5%) had prolonged period of unconsciousness, probably from hypothalamic disturbance. Cerebrospinal fluid leak developed in 10 (25.0%) cases. All patients required thyroxin and cortisol for replacement. Permanent diabetes insipidusdeveloped in 10 cases (25.0%). No cases required traditional, open approaches following endoscopic resection. Three patients required permanent CSF diversion via a ventriculo-peritoneal shunt after documentation of post-operative hydrocephalus.
Conclusion:Extendedtransspehnoidal approach is an excellent alternative of skull base approach for the removal of most of the craniopharyngiomas.It gives better visualization, improved postoperative visual outcome for less manipulation and lower complicationrate than craniotomy. However,CSF leak and DI are known common complications which shouldbe managed promptly and appropriately.
Craniopharyngioma, Extended endoscopic, transnasal, transphenoidal