Endoscopic Endonasal Excision of a Complex Craniopharyngioma Operated Multiple Times by Transcranial Route

Abstract

Complex craniopharyngiomas pose a significant surgical challenge owing to its proximity to critical structures and its intrinsic nature to resist radical excision. To show that endoscopic endonasal approach (EEA) is potentially a better alternative to transcranial approach in tumors that have been operated multiple times by transcranial route for achieving radical excision with minimal morbidity. A 32-year-old male previously operated twice through interhemispheric approach for craniopharyngioma presented with blurring of vision accompanied by headache and intermittent diplopia. Imaging revealed a large lobulated suprasellar recurrence with a large calcified part adjacent to left internal carotid artery. The tumor was resected by an extended endonasal approach. The patient experienced improvement in his vision with no significant endocrine complication. This case demonstrates the surgical technique and various operative nuances of endoscopic endonasal resection of a complex craniopharyngioma.