Trans-eyebrow supraorbital approach in large suprasellar craniopharyngioma surgery in adults: analysis of optic nerve length and extent of tumor resection. Original article.
One of the main drawbacks in the surgery of large craniopharyngiomas is the presence of a prefixed optic chiasm. Our main objective in this study is to compare the predictive value of the optic nerve length and optic chiasm location on large craniopharyngiomas' extent of resection.



We retrospectively studied 21 consecutive patients with large craniopharyngiomas who underwent tumor resection through the trans-eyebrow supraorbital approach. Clinical and radiological findings on preoperative MRI were recorded, including the optic chiasm location classified as prefixed, postfixed or normal. We registered the optic nerve length measured intraoperatively prior to tumor removal and confirmed the measurements on preoperative MRI. Using a linear regression model, we calculated a prediction formula of the percentage of the extent of resection as a function of optic nerve length.



On preoperative MRI, 15 patients were considered to have an optic chiasm in a normal location, 3 cases had a prefixed chiasm, and the remaining 3 had a postfixed chiasm. In the group with normal optic chiasm location, a wide range of percentage of extent of resection was observed (75-100%). The percentage of extent of resection of large craniopharyngiomas was observed to be dependent on the optic nerve length in a linear regression model (p < 0.0001). According to this model in the normal optic chiasm location group, we obtained an 87% resection in 9-mm optic nerve length patients, a 90.5% resection in 10-mm optic nerve length patients and 100% resection in 11-mm optic nerve length patients.



Optic chiasm location provides useful information to predict the percentage of resection in both prefixed and postfixed chiasm patients but not in the normal optic chiasm location group. Optic nerve length was proven to provide a more accurate way to predict the percentage of resection than the optic chiasm location in the normal optic chiasm location group.
Hospital Universitario y Politécnico La Fe, Valencia, Spain. ricprat@hotmail.com.|Department of Neurosurgery, Hospital La Fe, Paseo Alameda, 64-10°-pta 47, 46023, Valencia, Spain. ricprat@hotmail.com.|Hospitales NISA, Valencia, Spain. ricprat@hotmail.com.
Ricardo
R
Prat
Hospital Universitario y Politécnico La Fe, Valencia, Spain.|Hospitales NISA, Valencia, Spain.
Inma
I
Galeano
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Rocío
R
Evangelista
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Giovanni
G
Pancucci
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Juliana
J
Guarín
Fundación Hospital de Madrid, Madrid, Spain.
Angel
A
Ayuso
Palmdale Medical Center, Palmdale, CA, USA.
Mukesh
M
Misra
D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000601:surgery*; D005138:Eyebrows; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009900:Optic Nerve / Q000601:surgery*; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control
Craniopharyngioma; Optic chiasm; Optic nerve; Surgery; Trans-eyebrow supraorbital approach