Endoscopy-Assisted Microsurgical Removal of Giant Craniopharyngioma in Childhood

Abstract

Sixty-nine children suffering from craniopharyngioma were operated on between 1996 and 2004. Twenty-three of those children had very large tumors (diameter > 50 mm). Radical total microsurgical resection assisted by endoscopy was attempted in 19 patients. We performed in these cases a minimal pterionosubfrontal flap. The translamina terminalis approach was used for the retrochiasmatic tumors and the anterior/lateral subchiasmatic approach for prechiasmatic tumors. The success of our total resection of the tumor was evaluated by CT scan and MRI. None of the patients received radiotherapy postoperatively. The follow-up period ranged between 18 months and 4 years. Only 3 patients showed recurrences. Despite the fact that total removal was performed, we only witnessed 2 cases of postoperative neurological aggravation. Transient diabetes insipidus was seen in all cases. Hydrocephalus was present in 15 cases; only 5 required shunting. We hereby present our techniques and results. We conclude that good knowledge of the surgical and endoscopic anatomy of giant craniopharyngioma make total removal of these tumors possible with minimal complications, if any.