This action might not be possible to undo. Are you sure you want to continue?
Craniopharyngioma: Endoscopic Craniopharyngioma Surgery (Three Minimally Invasive Endoscopic Approaches to Craniopharyngiomas)
Traditionally, open surgery has been the main treatment or craniopharyngiomas! "o#ever, at the S$ull %ase Institute, three di erent minimally invasive endoscopic procedures allo# us to tailor the procedure o ered depending on the si&e and location o the tumor! 'or completely intrasellar craniopharyngiomas #ith no suprasellar e(tensions and no signi icant attachments to the optic chiasm, endoscopic transnasal approaches similar to those o ered or pituitary tumors are also o ered or these craniopharyngiomas! Craniopharyngiomas located in the suprasellar areas #ith adhesions to the optic chiasm are approached through a minimally invasive endoscopic approach by placing an incision #ithin the s$in crease in the bridge o the nose and by per orming a one centimeter $eyhole midline rontal craniotomy! )nder direct vision the tumor along #ith its adhesions to the chiasm is dissected and completely resected! This minimally invasive endoscopic rontal craniotomy approach is ideal or most craniopharyngiomas since they invariably e(tend to the suprasellar area and also invariably have adhesions to the chiasm! *atients are discharged #ithin t#enty+ our to orty+eight hours!
,ccasionally, craniopharyngiomas e(tend laterally beyond the midline! Craniopharyngiomas that e(tend laterally are approached through the most recent technical innovation at the S$ull %ase Institute, this ully endoscopic approach involves placing an incision #ithin the hair o the eyebro#, per orming a -+-!.cm $eyhole supraorbital opening and advancing the endoscope along the loor o the anterior cranial ossa underneath the rontal lobe! This approach allo#s a panoramic visuali&ation o the ipsilateral anterior ossa and a partial visuali&ation o the contralateral anterior ossa!
uic! "aunch Topics Craniopharyngioma #verview Craniopharyngioma $ymptoms Craniopharyngioma Treatment . occasionally giant lesions may require a combination of the endoscopic transnasal approach with either the endoscopic frontal approach or the endoscopic supraorbital approach.Although most craniopharyngiomas are completely resected through one of these minimally invasive approaches. This allows a complete and total resection of virtually most craniopharyngiomas from small completely intrasellar lesions all the way to giant craniopharyngiomas extending to the suprasellar area and also spilling laterally into the base of the anterior or middle cranial fossae. This can either be done simultaneously or can be staged as two separate procedures.
' by increasing the pressure on the brain %intracranial pressure' )' by disrupting the function of the pituitary gland. cys %full of fluid' or full of debris. they may show various degrees of calcification or bone formation (ue to their slow&growing characteristics. The clinical presentation of craniopharyngioma patients consists of a broad spectrum of symptom that range from completely asymptomatic %incidentally discovered' to endocrine. pharynx1throat. This explains the name of the tumor %cranio1s!ull. vomiting and difficulty with balance. which connects the pituitary gland to the brain %hypothalamus'. oma1tumor'. . They include symptoms related to an increase in the intracranial pressure %3C5' due to bloc!age of cerebrospinal fluid %C$6' pathways causing headache. The trigger that initiates tumor growth is not !nown. craniopharyngiom may rarely behave li!e malignant tumors and can metastasi0e. nausea.*+ of all brain tumors occurring in children. They may also cause hormonal manifestations due to pressure on the hypothalamus and pituitary gland causing obesity. The symptoms associated with a craniopharyngioma are related to its location and si0e. Craniopharyngiomas account for approximately ) & * + of all intracranial neoplasms and are mo common in childhood and adolescence. 3ncreased pressure on the brain Causes headache. nausea. Causes Craniopharyngiomas are congenital in origin. while othe have a progressively deteriorating clinical course. excessive thirst and urination %diabetes insipidus'.#verview Craniopharyngiomas are histologically benign %non&cancerous'.& . Craniopharyngiomas are uniformly benign and they produce no hormones. The craniopharyngeal duct %connecting the brain to the pharynx'. they can be solid. (espite its histologic appearance. $ymptoms A craniopharyngioma is a benign tumor that develops near the pituitary gland. these tumors can ta!e years to manifest themselves before a diagnosis is made. particularly peripheral vision due to direct pressure on the op nerves. Craniopharyngiom cause symptoms in three different ways2 . 4any patients remain asymptomatic for long periods of time. stunted growth and delayed developmental milestones. There is no sexual predisposition and both males and females are affected equally. Craniopharyngiomas may be intrasellar or suprasellar and may cause various degrees of hypopituitarism by compression of the adenohypohysis %the anterior part of the pituitary gland'. their pea! age of discovery is between . is the embryonal structure along which the eventual adenohypophysis and infundibulum migrate. extraaxial %extrinsic to the brain' slow&growing tumors that occur exclusively in the region of the sella turcia %a bony depression located at the base of the s!ull where the pituitary gland resides' and are thought to be derived fr squamous cell nests of the hypohyseal stal!. and symptoms related to direct pressure they exert on the surrounding neurovascular structures such as decreased vision. or psychological disorders.&. and *' by damaging the optic pathways. visual. pituitary stal! or the hypothalamus. vomiting and difficulty with balance./ years and th represent .
ase.(iagnosis A thorough medical history and neurological examination are the first steps in the diagnosis. (ue to the frequently associated visual and endocrine dysfunction with craniopharyngiomas. Complete radiological investigations to select the proper treatment protocol and identify tumors t may require staged surgical operations. . and the neurological deficits and hormonal imbalances caused by the tumor at time of treatment. surgery has been the main treatment for craniopharyngiomas. However. $hahinian H92 <ndoscopic Transglabellar Approach to The Anterior 6ossa and 5aranasal $inuses. The imaging tests include magnetic resonance imaging %473' and computed tomography %CT' scanning both performed with and without intravenous contrast. an ophthalmological and endocrinological baseline evaluation is frequently performed. . including the ability of the tum to be completely removed. 3f possible.erci 8. $ometimes these treatments may be combined especially in cases of residual tumor following surgery. As craniopharyngiomas are primarily tumors of childhood and the usual course is progressive. • $hahinian H92 Tumors and $urgery of the $!ull . Treatment Traditionally. Cha $T. Articles: • :arrahy 7. and to denote the si0e and extent of the craniopharyngiom must then follow. radiation therapy %conventional or gamma !nife %89'' and intra&tumoral chemotherapy may be applicable for some patients. radiation and chemotherapy is withheld in younger children prevent their delayed side effects. 5rognosis 3n general the prognosis is good. ea treatment avoids the occurrence of undesired complications. but it depends on several factors.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.