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Surgical Approach to Craniopharyngiomas: Transcranial Routes

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Diagnosis and Management of Craniopharyngiomas

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Abstract

The optimal treatment of patients with craniopharyngioma remains controversial because an effective balanced protocol between aggressive therapy and reducing adverse sequelae is still lacking.

Radical resection is considered the therapy of choice for primary treatment, being associated with the best outcome in terms of survival and recurrence-free survival.

Transcranial surgery is performed in case of purely suprasellar or large intra-suprasellar dumbbell-shaped tumors, with extension toward the third ventricle and hypothalamus, subfrontal, retrochiasmatic, and retro-sellar regions.

Transcranial approaches comprise the frontopterional, the fronto-orbito-zygomatic (FOZ), and the combined interhemispheric subcommissural translaminaterminalis approach (CISTA).

The most relevant anatomic elements influencing the extent of resection and potential effectiveness of surgery, as well as the risk of surgical morbidity in craniopharyngioma surgery are tumor relationships with the third ventricle and hypothalamus, arachnoid plane and pia mater layer, optic pathways, pituitary stalk and vascular structures.

We discuss and comparatively analyze the role of FOZ, and CISTA in terms of indication, peculiar features and technique in the surgical treatment of craniopharyngiomas.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Pietro Mortini MD, Filippo Gagliardi MD, Michele Bailo MD & Marco Losa MD

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  1. Pietro Mortini MD
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  2. Filippo Gagliardi MD
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  3. Michele Bailo MD
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  4. Marco Losa MD
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Correspondence to Filippo Gagliardi MD .

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Editors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Rozzano, Italy

    Andrea Lania

  2. DISCO Department Endocrinology and Diabetology Unit, University of Milan IRCCS Fondazione Policlinico Milano, Milan, Italy

    Anna Spada

  3. Neurosurgery Department, Istituto Clinico Humanitas, Rozzano (MI), Italy

    Giovanni Lasio

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Mortini, P., Gagliardi, F., Bailo, M., Losa, M. (2016). Surgical Approach to Craniopharyngiomas: Transcranial Routes. In: Lania, A., Spada, A., Lasio, G. (eds) Diagnosis and Management of Craniopharyngiomas. Springer, Cham. https://doi.org/10.1007/978-3-319-22297-4_5

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  • DOI: https://doi.org/10.1007/978-3-319-22297-4_5

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