Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases.
OBJECTIVE
Craniopharyngiomas are challenging tumors to resect due to their deep location and proximity to vital structures. The perceived benefit of gross total resection may be tempered by the possibility of permanent disability. Minimally invasive techniques may reduce surgical morbidity while still allowing effective resection. The authors describe their initial experience with a neuroendoscopic transcortical, transventricular approach to two craniopharyngiomas. The surgeries were performed through a right frontal burr hole using the NICO Myriad, a side-cutting, aspiration device that fits through the working channel of a standard neuroendoscope.


METHODS
The imaging and medical records of two children (a 5-year-old male and a 9-year-old female) undergoing endoscopic resection of a craniopharyngioma with this technique were reviewed. Outcomes, results, and complications were noted.


RESULTS
A gross total resection was achieved in both patients. The operative time was 180 and 143 min, respectively. The estimated blood loss was 20 and 50 cm3, respectively. Both patients required a cerebrospinal fluid shunt. There were no surgical complications.


CONCLUSIONS
The NICO Myriad is an effective tool that allows a safe minimally invasive endoscopic resection of craniopharyngiomas in patients with amenable anatomy. Surgeons with experience in neuroendoscopy may be able to achieve a gross total resection of these challenging tumors through a minimally invasive burr hole approach.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Reilin J
RJ
Moore
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA.
Andrea
A
Scherer
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA. dfulkers@iupui.edu.|Goodman Campbell Brain and Spine, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive #1134, Indianapolis, IN, 46202-5200, USA. dfulkers@iupui.edu.
Daniel H
DH
Fulkerson
D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D044583:Neuroendoscopy / Q000379:methods*; D059906:Neuroimaging; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013396:Suction / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
Craniopharyngioma; Endoscopic; Minimally invasive; NICO Myriad; Surgical technique