Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma with Fascia Lata Button and Nasoseptal Flap Reconstruction

Varun R. Kshettry; Gurston Nyquist; James J. Evans

doi:10.1055/s-0037-1620260

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC-BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 02): S191-S193
DOI: 10.1055/s-0037-1620260

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma with Fascia Lata Button and Nasoseptal Flap Reconstruction

Varun R. Kshettry

¹Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States

,

Gurston Nyquist

²Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

,

James J. Evans

³Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

› Author Affiliations

Abstract

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Keywords

endonasal - surgical technique - video - suprasellar - transinfundibular

Fig. 1 Preoperative (a, b) T1 postgadolinium MRI views demonstrating a large cystic and solid suprasellar mass with compression of the hypothalamus bilaterally. Postoperative (c, d) T1 postgadolinium MRI demonstrating complete resection with healing of vascularized nasoseptal flap to the skull base. MRI, magnetic resonance imaging.

Fig. 2 Intraoperative views. (a) Adequate bony exposure includes drilling the lateral tubercular strut to open the opticocarotid region. (b) Initial arachnoidal dissection proceeds at the midline, mobilizing the superior hypophyseal arteries (arrows) laterally, preserving any branches going to the optic apparatus. (c) Final tumor (T) resection, visualized is the hypothalamus (H), third ventricular floor (*), mammillary bodies (m), and right posterior communicating artery (arrow). (d) Dural reconstruction performed with inlay/onlay fascia lata button graft with four sutures used to secure the two grafts together at the dural margins. ON, optic nerve; ICA, internal carotid artery; *lateral opticocarotid recess; T, tumor.

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Fig. 1 Preoperative (a, b) T1 postgadolinium MRI views demonstrating a large cystic and solid suprasellar mass with compression of the hypothalamus bilaterally. Postoperative (c, d) T1 postgadolinium MRI demonstrating complete resection with healing of vascularized nasoseptal flap to the skull base. MRI, magnetic resonance imaging.

Fig. 2 Intraoperative views. (a) Adequate bony exposure includes drilling the lateral tubercular strut to open the opticocarotid region. (b) Initial arachnoidal dissection proceeds at the midline, mobilizing the superior hypophyseal arteries (arrows) laterally, preserving any branches going to the optic apparatus. (c) Final tumor (T) resection, visualized is the hypothalamus (H), third ventricular floor (*), mammillary bodies (m), and right posterior communicating artery (arrow). (d) Dural reconstruction performed with inlay/onlay fascia lata button graft with four sutures used to secure the two grafts together at the dural margins. ON, optic nerve; ICA, internal carotid artery; *lateral opticocarotid recess; T, tumor.