The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas.
OBJECTIVE
We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique.


METHODS
Four cadaveric specimens fixed with gluteraldehyde and injected with latex were dissected to illustrate the approach.


RESULTS
The surgical steps of the approach are reported. The ACoA anatomy was studied. In particular, the surgical route in-between and lateral to the first and second segments of the anterior cerebral artery and the ACoA complex were examined. The approach was adopted in a clinical setting; two illustrative cases regarding the removal of large craniopharyngiomas with suprasellar extension through this route are described.


CONCLUSIONS
The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas.
Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Pietro
P
Mortini
Filippo
F
Gagliardi
Nicola
N
Boari
Fabio
F
Roberti
Anthony J
AJ
Caputy
D000328:Adult; D019412:Anatomy, Cross-Sectional; D002102:Cadaver; D002536:Cerebral Arteries / Q000601:surgery; D003397:Craniopharyngioma / Q000150:complications / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D005404:Fixatives; D005976:Glutaral; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009900:Optic Nerve / Q000033:anatomy & histology; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D020542:Third Ventricle / Q000033:anatomy & histology / Q000601:surgery; D016707:Tissue Fixation; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology
D005404:Fixatives; D005976:Glutaral