Chapter 17 – Endonasal Resection of Craniopharyngiomas: Post-operative Management

Craniopharyngiomas are formidable tumors; their predilection for the suprasellar space and ability to adhere to surrounding structures renders their safe removal a daunting challenge. Several approaches have been proposed for their surgical treatment, including pterional-transsylvian, fronto-lateral, supraorbital, interhemispheric, subfrontal, transsphenoidal and even transpetrosal approaches. Recent advances in technology and a more thorough understanding of skull base anatomy from a ventral perspective have allowed the addition of the endonasal corridor under endoscopic visualization to the armamentarium of the skull base surgeon who deals with these lesions. The expanded endonasal approaches (EEAs), specifically the transsellar, transtuberculum, and transplanum modules, offer several advantages over their transcranial counterparts: direct visualization of the main tumor component and vital surrounding structures without the need for any brain or optic apparatus retraction is the main benefit over traditional techniques. The endonasal corridor grants ample access to the sellar and suprasellar compartments, as well as the anterior, middle, and posterior cranial fossae, when necessary. Direct visualization of the superior hypophyseal arteries, pituitary stalk and optic nerves and chiasm enables safe, microsurgical dissection of these structures from the tumor surface. Finally, the ventral perspective provides the surgeon with a superb view of the walls of the third ventricle, provided the tumor has violated them, a notoriously difficult area to safely access from a transcranial route.