Endoscopic management of craniopharyngiomas

Craniopharyngiomas are deep-seated anterior skull base lesions that are challenging to treat because of their location and locally aggressive behavior. In recent years, the endoscopic, endonasal technique has been developed for craniopharyngioma surgery to overcome the limitations of previously established microscope-based transcranial and transsphenoidal approaches. The endoscopic, endonasal technique provides a direct path to the tumor with panoramic visualization. Through the transsphenoidal surgical corridor, the endoscopic skull base surgeon can target the craniopharyngioma tumor located within the sella, suprasellar cistern, third ventricle, and prepontine cistern. The initial outcome data from endoscopic, endonasal case series in terms of extent of resection, vision improvement, and hypothalamic-pituitary dysfunction have been encouraging, although further follow-up of treated patients and analysis of outcomes are needed. We describe our technique for treating craniopharyngiomas via a fully endoscopic, endonasal, extended transsphenoidal approach.