The Combined Interhemispheric Subcommissural Translaminaterminalis Approach for Large Craniopharyngiomas

Objective We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was cond...

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Bibliographic Details
Published in:World neurosurgery 2013-07, Vol.80 (1), p.160-166
Main Authors: Mortini, Pietro, Gagliardi, Filippo, Boari, Nicola, Roberti, Fabio, Caputy, Anthony J
Format: Article
Language:English
Subjects:
Adult
Anatomy, Cross-Sectional
Anterior communicating artery
Cadaver
Cerebral Arteries - surgery
Craniopharyngioma - complications
Craniopharyngioma - surgery
Craniopharyngiomas
Craniotomy - methods
Female
Fixatives
Glutaral
Humans
Interhemispheric approach
Magnetic Resonance Imaging
Middle Aged
Neurosurgery
Neurosurgical Procedures - methods
Optic Nerve - anatomy & histology
Pituitary Neoplasms - complications
Pituitary Neoplasms - surgery
Third Ventricle - anatomy & histology
Third Ventricle - surgery
Tissue Fixation
Translaminaterminalis
Treatment Outcome
Vision Disorders - etiology
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Summary:Objective We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique. Methods Four cadaveric specimens fixed with gluteraldehyde and injected with latex were dissected to illustrate the approach. Results The surgical steps of the approach are reported. The ACoA anatomy was studied. In particular, the surgical route in-between and lateral to the first and second segments of the anterior cerebral artery and the ACoA complex were examined. The approach was adopted in a clinical setting; two illustrative cases regarding the removal of large craniopharyngiomas with suprasellar extension through this route are described. Conclusions The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2012.06.042