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

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Reilin J. Moore

  2. Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA

    Andrea Scherer & Daniel H. Fulkerson

  3. Goodman Campbell Brain and Spine, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive #1134, Indianapolis, IN, 46202-5200, USA

    Daniel H. Fulkerson

Authors
  1. Reilin J. Moore
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  2. Andrea Scherer
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  3. Daniel H. Fulkerson
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Corresponding author

Correspondence to Daniel H. Fulkerson.

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Conflict of interest

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

Electronic supplementary material

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

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Moore, R.J., Scherer, A. & Fulkerson, D.H. Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases. Childs Nerv Syst 33, 659–664 (2017). https://doi.org/10.1007/s00381-017-3386-1

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  • DOI: https://doi.org/10.1007/s00381-017-3386-1

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