Radical Resection of a Craniopharyngioma via the Extradural Temporopolar Approach

Objective: Though the extradural temporopolar approach (EDTPA) is useful, there are only few reports of this approach being used for craniopharyngioma resection. Herein, we report our surgical case series and the technical importance of EDTPA for the radical removal of a craniopharyngioma.

Methods: We report seven cases of craniopharyngiomas treated surgically between April 1999 and October 2015. The surgical approaches, clinical presentation, pre- and postoperative radiographic examination results, surgical outcomes, and morbidity have been analyzed.

Results: The mean follow-up period was 89.1 months. The surgical approach was EDTPA with zygomatic osteotomy in 4, combined interhemispheric trans-lamina terminalis approach and anterior temporal approach (ATA) in 2, and interhemispheric trans-lamina terminalis approach in 1 patient. Complete tumor resection was achieved in all cases, without any recurrence during the follow-up period. Transient morbidities were oculomotor nerve palsy in 2, and meningitis and hydrocephalus in 1 patient. There was 1 case of permanent morbidity due to hydrocephalus that needed a ventriculoperitoneal shunt, and 1 case of blindness on the operative side. Visual acuity and visual field improved in 4 cases, showed no change in 2 cases, and deteriorated in 1 case. Though the pituitary stalk was preserved in two cases, all seven cases needed total hormone replacement therapy.

Conclusion: EDTPA ensures sufficient mobility of the internal carotid artery, and provides a good lateral and “look up” operative view. Hence, it can be used effectively for radical resection of craniopharyngiomas through the opticocarotid space and retrocarotid space.