The petrosal approach for the total removal of giant retrochiasmatic craniopharyngiomas in children.
OBJECTIVE
The surgical removal of retrochiasmatic craniopharyngiomas, particularly those of giant size, remains a formidable challenge. The posterior petrosal (or presigmoid transtentorial) approach provides wide, direct exposure of these tumors, which allows safe neurovascular dissection and facilitates their total removal.


METHODS
Two patients, one 7-year-old girl and one 4-year-old girl, harboring giant retrochiasmatic craniopharyngiomas underwent total resection via the posterior petrosal approach. Both patients had good outcomes, and no evidence of recurrence was noted in either patient after 3 years of follow up. The surgical technique used in these patients is described. The trajectory of the petrosal approach is posterior-to-anterior and inferior upward. This is particularly valuable for dissecting the upper portion of the tumor, which projects high into the third ventricle. Using this approach, the surgeon can achieve direct visualization for dissection of the hypothalamus and pituitary stalk, while maintaining the blood supply to these structures and preserving their functional integrity. The small and poorly aerated mastoid sinus in children does not contraindicate the use or diminish the advantages of the petrosal approach.


CONCLUSIONS
The authors recommend this approach for patients with large or giant retrochiasmatic craniopharyngiomas.
Al-Mefty
Ossama
O
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA. keelandamye@uams.edu
Ayoubi
Samer
S
Kadri
Paulo A S
PA
D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D009897:Optic Chiasm / Q000473:pathology; D010579:Petrous Bone / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D020542:Third Ventricle / Q000473:pathology; D016896:Treatment Outcome