Hybrid Microscopic-Endoscopic Surgery for Craniopharyngioma in Neurosurgical Suite: Technical Notes.
OBJECTIVE
The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite.


METHODS
Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously.


RESULTS
Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery.


CONCLUSIONS
Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma.
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. Electronic address: tomoichi@cc.okayama-u.ac.jp.
Tomotsugu
T
Ichikawa
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Yoshihiro
Y
Otani
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Joji
J
Ishida
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Kentaro
K
Fujii
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Kazuhiko
K
Kurozumi
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Neurosurgery 2, Kawasaki Medical University, Okayama, Japan.
Shigeki
S
Ono
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Isao
I
Date
D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D018365:Neoplasm, Residual / Q000601:surgery; D044583:Neuroendoscopy / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014794:Visual Fields; D014839:Vomiting / Q000209:etiology
Craniopharyngioma; Endoscope; Ergonomics; Hybrid surgery; Microscope; Neurosurgical suite