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An endoscopic endonasal approach to craniopharyngioma via the infrachiasmatic corridor: a single center experience of 84 patients

  • Original Article - Brain Tumors
  • Published:
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Abstract

Object

The infrachiasmatic corridor is the most important surgical access route for craniopharyngiomas and was identified and used in clinical series. The aims of this study were to describe the characteristics that assist dissection and resection rates in endoscopic surgery of solid, cystic, and recurrent cases and their importance in the infrachiasmatic corridor in endoscopic surgery.

Methods

One hundred operations on 84 patients with pathologically identified craniopharyngioma were included in the study. The MRI findings were evaluated, and the location of the lesions was classified as (1) infrasellar; (2) sellar; or (3) suprasellar. In the sagittal plane, we measured the longest diameter of cystic and solid components and the height of chiasm-sella. Images were assessed for the extent of resection and were classified as gross total resection. This was deemed as the absence of residual tumor and subtotal resection, which had residual tumor.

Results

The infrasellar location was reported in 7/84 (8.3%) patients, the sellar location in 8/84 (9.5%), and the suprasellar location in 69/84 (82.1%) patients. The narrow and high chiasm-sella were observed in 28/69 (40.5%) and 41/69 patients (59.4%), respectively. The mean distance of the chiasm-sella was 9.46± 3.76. Gross total tumor resection was achieved in 60/84 (71.4%) and subtotal tumor resection was performed in 24/84 (28.6%) patients. The results revealed that suprasellar location (OR: 0.068; p = 0.017) and recurrent cases (OR: 0.011; p<0.001) were negative predictive factors on GTR. Increasing the experience (OR: 42,504; p = 0.001) was a positive predictor factor for GTR.

Conclusion

An EETS approach that uses the infrachiasmatic corridor is required for skull base lesions extending into the suprasellar area. The infrachiasmatic corridor can determine the limitations of endoscopic craniopharyngioma surgery. This corridor is a surgical safety zone for inferior approaches.

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Abbreviations

MRI:

magnetic resonance imaging

EETS:

extended endoscopic transsphenoidal surgery

DI:

diabetes insipidus

DTI:

diffusion tensor imaging

FA:

fractional anisotropy

MD:

mean diffusivity

BAM:

basal arachnoid membrane

LM:

Liliequist’s membrane

DL:

diencephalic leaf

ML:

mesencephalic leaf

PRL:

prolactin

GH:

growth hormone

IGF-1:

insulin-like growth factor 1

FSH:

follicle stimulating hormone

LH:

luteinizing hormone

TSH:

thyroid stimulating hormone

FT4:

free thyroxine

ACTH:

adrenocorticotropic hormone

CSF:

cerebrospinal fluid

OCT:

optical coherence tomography

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Authors and Affiliations

  1. Neurosurgery Department, Pituitary Research Center, Kocaeli University, Kocaeli, Turkey

    Savas Ceylan, Atakan Emengen, Eren Yilmaz, Burak Cabuk & Ihsan Anik

  2. Neurosurgery Department, Taksim Education and Research Hospital, Istanbul, Turkey

    Melih Caklili

  3. Radiology Department, Kocaeli University, Kocaeli, Turkey

    Yonca Anik

  4. Endocrinology Department, Kocaeli University, Kocaeli, Turkey

    Alev Selek

  5. Pediatric Endocrinology Department, Kocaeli University, Kocaeli, Turkey

    Filiz Cizmecioglu

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  1. Savas Ceylan
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Correspondence to Savas Ceylan.

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Ceylan, S., Caklili, M., Emengen, A. et al. An endoscopic endonasal approach to craniopharyngioma via the infrachiasmatic corridor: a single center experience of 84 patients. Acta Neurochir 163, 2253–2268 (2021). https://doi.org/10.1007/s00701-021-04832-0

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