The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle.
The third ventricle has historically represented one of the most challenging areas to access surgically, so that lesions directly harboring into the ventricular chamber or secondarily extending into it from adjacent areas have been approached by means of different transcranial routes. The aim of this work is to report our experience with the endoscopic endonasal approach in the management of a series of patients affected by craniopharyngiomas, extending into or arising from the third ventricle, evaluating pros and cons of this technique, also in regards of the anatomy and the pathology dealt with. During the period between January 2001 and February 2011, 12 patients, 9 male and 3 female (mean age 50.4 years; range 12-68) underwent an endoscopic endonasal approach for the treatment of a craniopharyngioma involving or arising from the third ventricle. According to the grade of involvement of the third ventricle, we identified three main ventricular growth patterns: (1) stalk-infundibulum; (2) infundibulum-ventricular chamber; (3) stalk-infundibulum-ventricular chamber. Though gross total removal was achieved in eight patients (66.7%), in three patients (25%) was possible a near total removal (>95%) and only in one case (8.3%) tumor removal has been partial (<50%). The overall analysis revealed a rate of 77.8% improvement of post-operative visual defects. Concerning the complications, we reported an overall CSF rate of 16.7%; two patients developed a subdural hematoma that has been treated with a surgical drainage. One patient died after the occurrence of a brainstem hemorrhage. The endoscopic endonasal route provides a good exposure, especially of the sub- and retro-chiasmatic areas, as well as of the stalk-infundibulum axis, which represents, when directly involved by a lesion, a gate to access the third ventricle chamber. Despite this study reporting only a preliminary experience, it seems that in properly selected cases--namely tumors growing mostly along the pituitary stem-infundibulum-third ventricle axis--this approach could be advocated as a valid route among the wide kaleidoscope of surgical approaches to the third ventricle.
Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy. lcavallo@unina.it
Luigi Maria
LM
Cavallo
Domenico
D
Solari
Felice
F
Esposito
Paolo
P
Cappabianca
D000368:Aged; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D004703:Endocrine System / Q000502:physiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000033:anatomy & histology / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology