title: The "extended" endoscopic endonasal approach for the removal of a mixed intrasuprasellar germinoma: Technical case report.
abstract: BACKGROUND
  Intracranial germ cell tumors (GCTs) represent less than 5% of pediatric brain tumors. Neurosurgical treatment remains essential in the management of patients with intracranial nongerminomatous GCT.
  
  
  METHODS
  A 12-year-old girl presented with clinical features of neurohypophyseal dysfunction and rapidly progressive visual worsening. Magnetic resonance imaging (MRI) showed a lesion arising from the sella with a significant suprasellar component, compressing the optic chiasm and extending into the third ventricle. The tumor was removed via an endoscopic endonasal transtuberculum-transplanum approach and the histology revealed a mixed germinoma. In the postoperative course, a conspicuous improvement of visual function was observed; an early postoperative MRI showed near-total removal of the lesion. The patient was referred to pediatric oncologist for the adjunctive chemotherapy and radiotherapy.
  
  
  CONCLUSIONS
  The management of primary intracranial sellar and suprasellar germinomas still remains controversial. With this report we highlighted another possible surgical option among therapeutic strategies for these highly malignant tumors.
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Alberto Di
authors.initials: AD
authors.lastname: Somma
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Bronzoni
authors.affiliation: Department of Advanced Biomedical Sciences, Division of Pathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Elia
authors.initials: E
authors.lastname: Guadagno
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Maxillo-Facial Surgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Giovanni Orabona
authors.initials: GO
authors.lastname: Dell'aversana
authors.affiliation: Department of Advanced Biomedical Sciences, Division of Pathology, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: B S Marialaura Del Basso
authors.initials: BS
authors.lastname: De Caro
authors.affiliation: Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
keywords: Endoscopic endonasal surgery; intracranial germinoma; pediatric brain tumor; skull base surgery