Bifrontal transbasal interhemispheric approach for craniopharyngioma

Abstract Craniopharyngiomas occur in the central, or deep part of the brain and extend to key regions, including the hypothalamus and third ventricle. Access to these tumors is easy and many neurosurgeons are experienced in this surgery. However, total lesion removal is extremely difficult, except in the case of small tumors; accordingly, their recurrence rate is very high. Even surgery by experts in this field show no better results. Operative procedures are selected and combined on the basis of tumor extensions. This paper, based on our own experience, describes the key points and pitfalls of a bifrontal transbasal interhemispheric approach to a large craniopharyngioma extending anteriorly to the anterior skull base and posteriorly to the third ventricle. Also described are key points of sacrificing bridging veins, preserving olfactory nerves, treating perforating arteries, using endoscopy to observe the reverse side of chiasm, and the degree of feasible cut into the stalk.