title: Unilateral Basal interhemispheric approach through the sphenoid sinus to retrochiasmatic and intrasellar craniopharyngiomas: surgical technique and results.
abstract: OBJECTIVE
  In the treatment of craniopharyngioma, complete surgical removal offers the best chance of cure and recurrence prevention. The basal interhemispheric approach involves problems with difficulty resecting tumors in the retrochiasmatic space located behind the optic chiasm and inability to resect, under direct view, tumors extending into the sella turcica. We report our approach via the sphenoid sinus devised to resolve these problems.
  
  
  METHODS
  A unilateral basal interhemispheric approach is planned for tumor resection. In cases in which the prechiasmatic space is too narrow to be utilized or the tumor has extended into the sella turcica, the prechiasmatic space is expanded by shaving the sphenoid surface and the tuberculum sellae. If the tumor inside the sella turcica needs to be removed, the anterior wall of the sella turcica also is shaved to permit tumor resection.
  
  
  RESULTS
  This technique was applied to 7 cases in total (in 3 cases to achieve prechiasmatic space expansion and in 4 cases for intrasellar tumor resection). Gross total removal was achieved in 6 cases and subtotal removal in 1. Of the 6 cases with preoperative visual field defects, 5 showed alleviation of these defects. The 5 patients with partial hypopituitarism developed complete panhypopituitarism postoperatively. All 7 patients have not suffered from postoperative cerebrospinal fluid leakage and meningitis.
  
  
  CONCLUSIONS
  This approach allowed a working space to be secured even in cases with a narrow prechiasmatic space, allowing tumor freeing from the lower plane of the optic nerve and safe resection of the intrasellar tumor.
authors: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Electronic address: takayuki@nagasaki-u.ac.jp.
authors: Takayuki
authors: T
authors: Matsuo
authors: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Kensaku
authors: K
authors: Kamada
authors: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Tsuyoshi
authors: T
authors: Izumo
authors: Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000379:methods*; D009897:Optic Chiasm / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D012658:Sella Turcica / Q000601:surgery; D019291:Skull Base / Q000601:surgery; D013101:Sphenoid Sinus / Q000601:surgery*; D016896:Treatment Outcome
keywords: Craniopharyngioma; Skull base surgery; Transsphenoidal root; Unilateral basal interhemispheric approach