Endoscopic endonasal resection of a recurrent infrasellar craniopharyngioma

Abstract

Objectives: Craniopharyngiomas most commonly occupy in the sellar and suprasellar intracranial spaces. However, occasional accounts are made of infrasellar lesions. Recent endoscopic management of these tumors has challenged traditional microsurgical excision that involves more invasive transseptal or craniotomy approaches. We report a case of a recurrent nasopharyngeal-based craniopharyngioma that was completely resected using an endonasal endoscopic technique. We evaluate the efficacy of this approach in treating infrasellar lesions and its morbidity when compared to more traditional resection. Methods: A 31-year old man who presented with a recurrent nasopharyngeal craniopharyngioma underwent image-guided endoscopic endonasal resection. The complexity of the lesion, the operative techniques applied, and the patient’s outcome are described and supported with perioperative diagnostic images and intraoperative photographs. Results: Resection of this patient’s recurrent craniopharyngioma was carried to the level of bone along all aspects of the clival cavity and sphenoid sinus. Application of an image-guided system intraoperatively assisted in protection of the pituitary sella, carotid arteries, and optic nerves. The patient experienced no perioperative sequelae. He remains disease-free 1 year following resection and postoperative radiation therapy. Conclusion: Recurrent infrasellar craniopharyngiomas can be successfully managed using an image-guided endoscopic endonasal technique. This minimally invasive approach facilitated the resection of a recurrent tumor that had failed a microsurgical transseptal approach.