Craniopharyngioma: Comparison Between Supra-orbital Versus Endonasal Keyhole Approaches

  • Nancy McLaughlin
  • Amin B. Kassam
  • Daniel M. Prevedello
  • Domenico Solari
  • Kiarash Shahlaie
  • Nasrin Fatemi
  • Ricardo L. Carrau
  • Daniel F. Kelly
Part of the Tumors of the Central Nervous System book series (TCNS, volume 8)


Craniopharyngiomas represent one of the most challenging brain tumors to treat. In recent years, minimally invasive keyhole approaches have been increasingly used to remove these sellar, suprasellar and parasellar lesions. Of these approaches, the two most commonly used are the extended endonasal transsphenoidal route and the supraorbital eyebrow craniotomy. Although both approaches may be appropriate for a given patient, in many cases one route offers a better opportunity for safe and maximal tumor removal. Based on our combined experience using the endonasal and supra-orbital approaches for craniopharyngiomas, the endonasal route is preferred for removal of most retrochiasmal craniopharyngiomas and those lesions that are predominantly sellar in location. In contrast, those tumors that are predominantly prechiasmal or with prominent lateral extensions (a minority of craniopharyngiomas), the supra-orbital route is recommended. In some complex tumors with both prechiasmal and retrochiasmal extensions, either route may be appropriate. An additional key factor is surgeon experience with these keyhole approaches and conventional approaches. Compared to conventional larger craniotomies, the major limitation of both the endonasal and supraorbital approaches is a narrow surgical corridor. The endonasal approach has the added challenges of restricted lateral access, a greater need for endoscopy as well as a more demanding skull base repair. Herein, we review in this chapter the use of the supraorbital and endonasal approaches and summarize tumor and patient characteristics that help determine the optimal surgical route.


Bone Flap Endonasal Approach Pericranial Flap Gross Total Removal Skull Base Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Dr Dennis Malkasian and Mr Josh Emerson for their artistic contribution.


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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Nancy McLaughlin
    • 1
  • Amin B. Kassam
    • 2
  • Daniel M. Prevedello
    • 3
  • Domenico Solari
    • 1
  • Kiarash Shahlaie
    • 4
  • Nasrin Fatemi
    • 1
  • Ricardo L. Carrau
    • 5
  • Daniel F. Kelly
    • 1
  1. 1.Brain Tumor CenterJohn Wayne Cancer Institute at Saint John’s Health CenterSanta MonicaUSA
  2. 2.Department of Surgery, Division of NeurosurgeryThe Ottawa Hospital Civic Campus at the University of OttawaOttawaCanada
  3. 3.Department of Neurological SurgeryWexner Medical Center at The Ohio State UniversityColumbusUSA
  4. 4.Department of NeurosurgeryUC DavisSacramentoUSA
  5. 5.Department of OtolaryngologyWexner Medical Center at The Ohio State UniversityColumbusUSA

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