title: Endoscopic transnasal craniotomy and the resection of craniopharyngioma.
abstract: OBJECTIVE
  To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma.
  
  
  METHODS
  Observational retrospective cohort study.
  
  
  METHODS
  Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow-up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach).
  
  
  RESULTS
  Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation +/- 16.3). Mean tumor size was 3.2 cm (standard deviation +/- 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs.
  
  
  CONCLUSIONS
  The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near-field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two-surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach.
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Hospital Prof. Edmundo Vasconcelos, Sao Paulo, SP, Brazil.
authors.forename: Aldo C
authors.initials: AC
authors.lastname: Stamm
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vellutini
authors.forename: Richard John
authors.initials: RJ
authors.lastname: Harvey
authors.forename: João Flávio
authors.initials: JF
authors.lastname: Nogeira
authors.forename: Diego R
authors.initials: DR
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003397:Craniopharyngioma / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome