Endoscopic transnasal surgery for craniopharyngiomas

GUI Songbai

Abstract：Located in the central core region of the skull base,with diverse growth patterns and anatomical positions,craniopharyngiomas are adjacent to critical nerves,blood vessels,the brainstem,and the hypothalamus,making surgical treatment a significant challenge to neurosurgeons. With the rapid advancements in endoscopic skull base surgery techniques,equipment,and instruments,as well as the continuous accumulation of surgical experience,the surgical techniques of endonasal endoscopic treatment for craniopharyngioma have been continuously improved,from resection of intrasellar craniopharyngioma at early stage to removal of craniopharyngioma invading suprasellar and third ventricle. More importantly,this approach has also evolved from being only applicable to resection of craniopharyngiomas in adults to being suitable for infants and children as well. This technique naturally possesses plenty of advantages,including the operational angle aligned with the growth direction of craniopharyngioma,the possibility of close observation to eliminate blind spots and dead corners,and the capability of separating the tumor from the surrounding critical structures under direct vision. These traits contribute to reducing surgical injury,increasing total resection rate,and finally,improving the surgical quality of craniopharyngioma effectively. At present,the endonasal endoscopic approach should be the preferred treatment strategy for most infants,children,and adults with craniopharyngiomas.