Surgical removal of retrochiasmatic craniopharyngiomas with transpetrosal approach

Abstract

Although there is general agreement that surgery is the preferred treatment for craniopharyngiomas, the extent of resection and optimal approach are still debated. Since 1973 our institute has used the transpetrosal approach to remove cerebellopontine angle and clivus tumors. We also prefer this approach for the removal of retrochiasmatic craniopharyngiomas. The principal advantage of the transpetrosal approach is that it allows the hypothalamus, the wall of the third ventricle, and the inferior surface of the optic chiasm to be visualized directly during surgery. Between 1980 and 2002, 28 patients with retrochiasmatic craniopharyngiomas underwent a combined anterior and posterior transpetrosal approach with a partial labyrinthectomy. The mean follow-up was 13.6 years (range, 0.8–23 years). Total removal of the tumor was confirmed in 25 (89%) cases. Preoperatively, patients had a visual disturbance, which improved in 10 cases, worsened 3 cases, and was unchanged in 1 case. This approach is useful for the aggressive surgical treatment of retrochiasmatic craniopharyngiomas.