Child's Nervous System

, Volume 33, Issue 4, pp 659–664 | Cite as

Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases

  • Reilin J. Moore
  • Andrea Scherer
  • Daniel H. Fulkerson
Technical Notes



Craniopharyngiomas are challenging tumors to resect due to their deep location and proximity to vital structures. The perceived benefit of gross total resection may be tempered by the possibility of permanent disability. Minimally invasive techniques may reduce surgical morbidity while still allowing effective resection. The authors describe their initial experience with a neuroendoscopic transcortical, transventricular approach to two craniopharyngiomas. The surgeries were performed through a right frontal burr hole using the NICO Myriad, a side-cutting, aspiration device that fits through the working channel of a standard neuroendoscope.


The imaging and medical records of two children (a 5-year-old male and a 9-year-old female) undergoing endoscopic resection of a craniopharyngioma with this technique were reviewed. Outcomes, results, and complications were noted.


A gross total resection was achieved in both patients. The operative time was 180 and 143 min, respectively. The estimated blood loss was 20 and 50 cm3, respectively. Both patients required a cerebrospinal fluid shunt. There were no surgical complications.


The NICO Myriad is an effective tool that allows a safe minimally invasive endoscopic resection of craniopharyngiomas in patients with amenable anatomy. Surgeons with experience in neuroendoscopy may be able to achieve a gross total resection of these challenging tumors through a minimally invasive burr hole approach.


NICO Myriad Craniopharyngioma Endoscopic Minimally invasive Surgical technique 



The authors appreciate the photographs in Fig. 1 provided by NICO and Jana Quigley.

Compliance with ethical standards

Conflict of interest

The authors have no financial or commercial interest in any of the devices or companies mentioned in the article.

Supplementary material

Video 1

Intraoperative video of the endoscopic approach, septostomy, and tumor resection of Patient #2. (MOV 374019 kb)


  1. 1.
    Al-Mefty O, Hassounah M, Weaver P, Sakati N, Jinkins JR, Fox JL (1985) Microsurgery for giant craniopharyngiomas in children. Neurosurgery 17:585–595CrossRefPubMedGoogle Scholar
  2. 2.
    Albright AL, Okechi H (2012) Use of the NICO Myriad device for tumor and cyst removals in a developing country. Childs Nerv Syst 28:599–604CrossRefPubMedGoogle Scholar
  3. 3.
    Dlouhy BJ, Dahdaleh NS, Greenlee JD (2011) Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad. Neurosurg Focus 30:E6CrossRefPubMedGoogle Scholar
  4. 4.
    Garcia-Navarro V, Lancman G, Guerrero-Maldonado A, Anand VK, Schwartz TH (2011) Use of a side-cutting aspiration device for resection of tumors during endoscopic endonasal approaches. Neurosurg Focus 30:E13CrossRefPubMedGoogle Scholar
  5. 5.
    McLaughlin N, Ditzel Filho LF, Prevedello DM, Kelly DF, Carrau RL, Kassam AB (2012) Side-cutting aspiration device for endoscopic and microscopic tumor removal. J Neurol Surg B Skull Base 73:11–20CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mohanty A, Thompson BJ, Patterson J (2013) Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of large intraventricular tumors. World Neurosurg 80(655):e615–e621Google Scholar
  7. 7.
    Muller HL (2016) Risk-adapted treatment and follow-up management in childhood-onset craniopharyngioma. Expert Rev Neurother 16:535–548CrossRefPubMedGoogle Scholar
  8. 8.
    Alli S, Isik S, Rutka JT (2016) Microsurgical removal of craniopharyngioma: endoscopic and transcranial techniques for complication avoidance. J NeurooncolGoogle Scholar
  9. 9.
    Leroy R, Benahmed N, Hulstaert F, Van Damme N, De Ruysscher D (2016) Proton therapy in children: a systematic review of clinical effectiveness in 15 pediatric cancers. Int J Radiat Oncol Biol Phys 95:267–278CrossRefPubMedGoogle Scholar
  10. 10.
    Jeswani S, Nuno M, Wu A, Bonert V, Carmichael JD, Black KL, Chu R, King W, Mamelak AN (2016) Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study. J Neurosurg 124:627–638CrossRefPubMedGoogle Scholar
  11. 11.
    Baldauf J, Hosemann W, Schroeder HW (2015) Endoscopic endonasal approach for craniopharyngiomas. Neurosurg Clin N Am 26:363–375CrossRefPubMedGoogle Scholar
  12. 12.
    de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A (2007a) Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61:219–227 discussion 228CrossRefPubMedGoogle Scholar
  13. 13.
    de Divitiis E, Cavallo LM, Cappabianca P, Esposito F (2007b) Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 60:46–58 discussion 58-49CrossRefPubMedGoogle Scholar
  14. 14.
    Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F (2006) The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59: ONS75-83; discussion ONS75-83Google Scholar
  15. 15.
    Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH (2013) Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 119:1194–1207CrossRefPubMedGoogle Scholar
  16. 16.
    Sankhla SK, Jayashankar N, Khan GM (2015) Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: surgical technique and results. J Pediatr Neurosci 10:308–316CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zacharia BE, Amine M, Anand V, Schwartz TH (2016) Endoscopic endonasal management of craniopharyngioma. Otolaryngol Clin N Am 49:201–212CrossRefGoogle Scholar
  18. 18.
    Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2012) Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 77:329–341CrossRefPubMedGoogle Scholar
  19. 19.
    Nakahara Y, Koga H, Maeda K, Takagi M, Tabuchi K (2004) Neuroendoscopic transventricular surgery for suprasellar cystic mass lesions such as cystic craniopharyngioma and Rathke cleft cyst. Neurol Med Chir (Tokyo) 44:408–413 discussion 414-405CrossRefGoogle Scholar
  20. 20.
    Delitala A, Brunori A, Chiappetta F (2004) Purely neuroendoscopic transventricular management of cystic craniopharyngiomas. Childs Nerv Syst 20:858–862CrossRefPubMedGoogle Scholar
  21. 21.
    Nakamizo A, Inamura T, Nishio S, Inoha S, Ishibashi H, Fukui M (2001) Neuroendoscopic treatment of cystic craniopharyngioma in the third ventricle. Minim Invasive Neurosurg 44:85–87CrossRefPubMedGoogle Scholar
  22. 22.
    Kim K, Yeon JY, Seol HJ, Shin HJ (2013) Transventricular endoscopic biopsy of suprasellar tumors: a pediatric case series. Childs Nerv Syst 29:1285–1291CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Reilin J. Moore
    • 1
  • Andrea Scherer
    • 2
  • Daniel H. Fulkerson
    • 2
    • 3
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and SpineIndiana University School of MedicineIndianapolisUSA
  3. 3.Goodman Campbell Brain and Spine, Riley Hospital for ChildrenIndiana University School of MedicineIndianapolisUSA

Personalised recommendations