Extended Endoscopic Endonasal Transplanum and Transdorsum Sellar Approach for the Resection of Retroinfundibular Craniopharyngioma With Two-Piece Dural Opening: A Technical Case Report

TL;DR

This case report describes a surgical technique for removing a brain tumor near the pituitary gland using an endoscopic approach with a two-piece dural opening to reduce complications.

Contribution

The paper introduces an extended endoscopic endonasal approach with a two-piece dural opening for retroinfundibular craniopharyngioma resection.

Findings

The transdorsum sellar approach with posterior clinoidectomy provides direct access to the lesion.

A two-piece dural opening helps prevent postoperative cerebrospinal fluid leakage.

Direct cyst puncture without cerebrospinal fluid drainage is effective for large cystic lesions.

Abstract

The surgical treatment of retroinfundibular craniopharyngiomas is challenging due to their location and the surrounding neurovascular structures. In this report, the transdorsum sellar approach with posterior clinoidectomy, the efficacy of direct cyst puncture, and the suitability of a two-piece dural opening are presented. A 56-year-old male with visual and cognitive disturbances was referred to our hospital. Preoperative CT and MRI demonstrated a mostly cystic lesion with calcifications in the suprasellar and retroinfundibular areas. The imaging findings were suspected craniopharyngioma, and an extended endoscopic endonasal transdorsum sellar approach with posterior clinoidectomy was performed for direct access to the lesion. Two pieces of the dura were opened to prevent postoperative CSF leakage. The patient’s postoperative course was uneventful. The endoscopic transdorsum sellar approach gives direct access to the posterior cranial fossa. A direct puncture of the cyst without CSF drainage is helpful for large cystic lesions. A two-piece dural opening is easy to suture and can reduce the chance of postoperative CSF leakage.

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