Endoscopic Endonasal Ipsilateral Posterior Clinoidectomy for Access to a Suprasellar Infundibulo-Tuberal Craniopharyngioma With a Narrow Chiasm-Pituitary Corridor: 2-Dimensional Operative Video

Pure intraventricular craniopharyngioma (IVC) and narrow chiasm-pituitary corridor (CPC) are considered limitations of the extended endoscopic endonasal transtuberculum approach (EEETA).1 Transcranial approaches have been advocated for IVC. Recently, several authors have reported that EEETA for resection IVC is safe and efficacious and should be considered an option.(2-4) Pascual et al(5,6) divided IVC into strict IVC and nonstrict IVC (infundibulo-tuberal type). However, whether strict IVC exists is still controversial until verified by pathological evidence(.7,8)A narrow CPC has been considered to be a relative contraindication. Although Omay et al9 found that the CPC value (ranging from 5.2 to 19.1 mm) had no relationship with their ability to achieve gross total resection during EEETA, it has not been verified in cases with CPC < 5 mm. Two surgical techniques have been reported to address this issue. One is the endoscopic endonasal translaminar terminalis approach.(10) The other is a pituitary transposition to increase the CPC. In rare situations, posterior clinoidectomy with dorsectomy is required to gain better exposure and maneuverability.(1,11-15) We present the case of a 41-year-old woman with an infundibulo-tuberal craniopharyngioma accompanied by an extremely narrow CPC, who underwent EEETA with extradural ipsilateral clinoidectomy and dorsum sellae downward transposition. Because of the relatively higher risk of postoperative panhypopituitarism for IVCs2 and the unawareness of whether the pituitary stalk was preservable during the exposing stage, we splitted the left pituitary gland4 instead of performing pituitary transposition or removing the whole gland. Gross total resection was achieved with the preservation of her visual and hypothalamic functions. The patient consented to surgery.