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- W4304992102 abstract "Craniopharyngiomas continue to be a challenge and controversy persists as to their best management. Serious risks arise from the devastating dysfunction due to perforating artery ischemia to the hypothalamus, optic chiasm and internal capsule. These risks are magnified in giant craniopharyngiomas that can expand into multiple compartments. Thus, a single surgical approach is insufficient to achieve adequate resection. Maximal surgical resection might require multiple approaches. The tumor may be severely adherent and ossified, making the preservation of perforating blood vessels to the optic apparatus and hypothalamus paramount and requires fine microsurgical dissection.1,2 Utilization of a skull base approach minimizes brain retraction and cortical exposure to maintain good cerebral and cognitive functions.3 A “glial envelope” often exists at the interface between tumor and brain and provides a safe plane for dissection.4 This plane can be lost on subsequent operations, thus the first surgery offers the best chance at gross total removal. Good outcomes are achievable with attentive postoperative care for electrolytes, fluid balance, and minimization of aseptic meningitis. Here, we describe the resection of an 8.4-cm craniopharyngioma in an 18-year-old boy presenting with vision loss and diencephalic seizures. The tumor occupied multiple intracranial compartments and extended laterally into both sylvian fissures, requiring bilateral craniotomies. The open cranial approach provided excellent visualization of critical structures such as the perforating arteries supplying the optic chiasm. Postoperatively, the patient experienced immediate subjective and objective improvement in his vision and had diabetes insipidus controlled with intranasal ddAVP. The patient consented to surgery and images. {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:,caption:,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_8ji0w7q3},{pub-id-type:other,content-type:media-source,id:Kaltura}]}" @default.
- W4304992102 created "2022-10-14" @default.
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- W4304992102 date "2022-09-14" @default.
- W4304992102 modified "2023-09-30" @default.
- W4304992102 title "Resection of Giant Craniopharyngioma, Contending With Multiple Compartments and Myriad Perforating Arteries: 2-Dimensional Operative Video" @default.
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- W4304992102 doi "https://doi.org/10.1227/ons.0000000000000402" @default.
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