Experience of transsphenoidal surgery for craniopharyngiomas (author's transl)

Abstract

Transsphenoidal surgery on four cases of craniopharyngioma is reported. The usefulness of this method and operative indications for craniopharyngioma are discussed. It may be concluded that this method is less invasive and safer for removal of the tumor, with preservation or even the possibility of improvement in the pituitary function, when the tumor is mainly located in the sella or slightly extended into the suprasellar portion. This was confirmed by a comparative study of the pre and post-operative hormonal state in three patients. To decide operative indications, it is necessary to demonstrate the exact location of the tumor. Pneumoencephalotomography, coronal and sagittal CT and/or metrizamide cisternography are the most reliable methods so far to delineate tumor extension. Admittedly, the absolute indication is mainly an intrasellar tumor with enlarged sella, although not many cases of craniopharyngioma are included in this type. Furthermore, transnasal drainage of the cyst or emergency decompression of the chiasm for suprasellar craniopharyngiomas may be indicated in some situations. For radical removal, it may be possible to use both the transsphenoidal and intracranial route simultaneously.