CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S254-S255
DOI: 10.1055/s-0038-1624589
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Orbitopterional Craniotomy Resection of Pediatric Suprasellar Craniopharyngioma

Devon LeFever
1   Department of Neurosurgery, LSU Health Science Center, Shreveport, Louisiana, United States
,
Chris Storey
1   Department of Neurosurgery, LSU Health Science Center, Shreveport, Louisiana, United States
,
Bharat Guthikonda
1   Department of Neurosurgery, LSU Health Science Center, Shreveport, Louisiana, United States
› Author Affiliations
Funding None.
Further Information

Address for correspondence

Devon LeFever, MD
Department of Neurosurgery, LSU Health Science Center
1501 Kings Hwy, Shreveport, LA 71103
United States   

Publication History

15 October 2017

14 December 2017

Publication Date:
26 February 2018 (online)

 

Abstract

The orbitopterional approach provides an excellent combination of basal access and suprasellar access. This approach also allows for less brain retraction when resecting larger suprasellar tumors that are more superiorly projecting due to a more frontal and inferior trajectory. In this operative video, the authors thoroughly detail an orbitopterional craniotomy utilizing a one-piece modified orbitozygomatic technique. This technique involves opening the craniotomy through a standard pterional incision. The craniotomy is performed using the standard three burr holes of a pterional approach; however, the osteotomy is extended anteriorly through the frontal process of the zygomatic bone as well as through the supraorbital rim. In this operative video atlas, the authors illustrate the operative anatomy, as well as surgical strategy and techniques to resect a large suprasellar craniopharyngioma in a 4-year-old male. Other reasonable approach options for a lesion of this size would include a standard pterional approach, a supraorbital approach, or expanded endoscopic transsphenoidal approach. The lesion was quite high and thus, the supraorbital approach may confine access to the superior portion of the tumor. While recognizing that some groups may have chosen the endoscopic expanded transsphenoidal approach for this lesion, the authors describe more confidence in achieving the goal of a safe and maximal resection with the orbitopterional approach.

The link to the video can be found at: https://youtu.be/eznsK16BzR8.


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Zoom Image
Fig. 1 Preoperative (A) and postoperative (B) sagittal T1 contrast-enhanced images demonstrating the resection of a larger suprasellar and superiorly projecting craniopharyngioma.
Zoom Image
Fig. 2 Intraoperative still image demonstrating the left optic nerve (ON), optic tract (OT), optic chiasm, and internal carotid artery (ICA). The tumor wall is noted in the prechiasmatic corridor and a portion of the cyst wall is seen in the retrochiasmatic corridor.

www.thieme.com/skullbasevideos

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Quality:

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Conflict of Interest

None.

Address for correspondence

Devon LeFever, MD
Department of Neurosurgery, LSU Health Science Center
1501 Kings Hwy, Shreveport, LA 71103
United States   

Zoom Image
Fig. 1 Preoperative (A) and postoperative (B) sagittal T1 contrast-enhanced images demonstrating the resection of a larger suprasellar and superiorly projecting craniopharyngioma.
Zoom Image
Fig. 2 Intraoperative still image demonstrating the left optic nerve (ON), optic tract (OT), optic chiasm, and internal carotid artery (ICA). The tumor wall is noted in the prechiasmatic corridor and a portion of the cyst wall is seen in the retrochiasmatic corridor.