title: Radical resection of a craniopharyngioma via the extradural anterior temporal approach with zygomatic arch osteotomy.
abstract: BACKGROUND
  Though the extradural anterior temporal approach (EDATA) with zygomatic osteotomy is useful, there are only few reports of this approach being used for craniopharyngioma resection. Herein, we report our surgical case series and the technical importance of EDATA for the radical removal of a craniopharyngioma.
  
  
  METHODS
  We report 7 cases of craniopharyngiomas treated surgically between April 1999 and October 2015. The surgical approaches, clinical presentation, pre and postoperative radiographic examination results, surgical outcomes, and morbidity were analyzed.
  
  
  RESULTS
  The mean follow-up period was 89.1 months. The surgical approach was EDATA with zygomatic osteotomy in 4, combined interhemispheric translamina terminalis approach (IHTLA) and trans-sylvian anterior temporal approach (ATA) in 2, and IHTLA in 1 patient. Complete tumor resection was achieved in all cases, without any recurrence during the follow-up period. Transient morbidities were oculomotor nerve palsy in 2, and meningitis and hydrocephalus in 1 patient. There was 1 case of permanent morbidity due to hydrocephalus that needed a ventriculoperitoneal shunt, and 1 case of blindness on the operative side. Visual acuity and visual field improved in 4 cases, showed no change in 2 cases, and deteriorated in 1 case. Though the pituitary stalk was preserved in 2 cases, all 7 cases needed total hormone replacement therapy.
  
  
  CONCLUSIONS
  EDATA with zygomatic osteotomy ensures sufficient mobility of the internal carotid artery, and provides a good lateral and look up operative view. Hence, it can be used effectively for radical resection of craniopharyngiomas through the opticocarotid space and retrocarotid space.
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Miyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Sakakibara
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Rihei
authors.initials: R
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyana
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Hokkaido, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
keywords: Anterior clinoidectomy; craniopharyngioma; extradural anterior temporal approach; transzygomatic approach