Craniopharyngioma Removal via Supraorbital Keyhole Approach

Research Article

Austin Neurosurg Open Access. 2014;1(2): 1007.

Craniopharyngioma Removal via Supraorbital Keyhole Approach

Zhu Qing, Yuan Liqun, Xu Liang, Sun Chao, Li Rujun and Lan Qing*

Department of Neurosurgery, Second Affiliated Hospital of Soochow University, China

*Corresponding author: Lan Qing, Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou 215004, China

Received: March 05, 2014; Accepted: May 07, 2014; Published: May 08, 2014


Objectives : For anterior surgical approaches to the suprasellar lesions, a relative larger craniotomy was always required in order to facilitate illuminating deeply several years ago. The improvement of surgical techniques, as well as the development of diagnostic imaging and the introduction of neuroendoscope, allows us to manage various intracranial lesions through a small keyhole. Although the supraorbital keyhole approach has nowadays gained ground in the surgeries of aneurysms and pituitary adenomas at suprasellar region, there are few descriptions of craniopharyngioma removal via such approach.

Methods : 17 patients with craniopharyngiomas were experienced 18 surgeries to remove the lesions via the keyhole approaches, including 17 supraorbital and 1 pterional keyhole approaches. The head MRI, ophthalmological and endocrinological assessments were conducted pre- and postoperatively to evaluate the therapeutic effects.

Results : Total resection of craniopharyngioma in 12 surgeries and subtotal resection in 6 surgeries were achieved. Obstructive hydrocephalus in 5 cases was resolved in one session after the removal of lesions. Visual acuity and visual field improved in 7 cases after operations, aggravated in 3 cases however, and 2 of them alleviated after the hyperbaric oxygen therapy. 8 patients experienced postoperative electrolyte disorder and diabetes insipidus temporarily, and 1 patient suffered from disturbance of consciousness for two days after the resection of lesion.

Conclusion : The supraorbital keyhole approach offers surgical possibilities with effective resection of lesion and less approach-related morbidity compared with the conventional craniotomy approaches in the surgery of craniopharyngiomas. It is most beneficial to remove lesions infiltrated into the third ventricle on account of recanalization of the obstructive cerebrospinal fluid pathway.

Keywords : Supraorbital keyhole approach; Craniopharyngioma; Microsurgery; Minimally invasive neurosurgery


Many different approaches to suprasellar lesions have been described during the past decades [1–5], including the pterional approach, the transcallosal approach, and the subfrontal approach as well. One kind of disadvantage for all these approaches are the relative extensive brain exposure and retraction that result in the increase of approach–related morbidity, but is not in relation to the lesions themselves. Therefore, the ultimate goal of neurosurgery ought to be the smallest approach–associated injury with the optimal surgical results [6,7].

The development of medical imaging over the past decades has not only brought out the more accurate diagnoses, but allowed us to study the elaborate intracranial anatomy individually [8–12]. Understanding almost all anatomical details about the vicinity of lesions in advance, we can constitute the appropriate surgical strategies that are propitious to the lesions and anatomical structures of individual patient. All these improvements play an important role in the development of the keyhole neurosurgery [13].

As the most common congenital benign neoplasm at suprasellar region, craniopharyngioma is deep–seated and surrounded by nerves and vessels, which gives rise to the dramatic difficulty of surgical resection totally. By means of the combination of “keyhole effect” and skull base surgical skills, keyhole approaches have been widelyused in the surgery of aneurysms of anterior Willis circle as well as giant pituitary adenomas at suprasellar region [14–16]. In spite of the differences of hardness and content between craniopharyngioma and pituitary adenoma, we attempt to remove craniopharyngioma via the supraorbital keyhole approach due to their similar location and vicinity.

Patients and Methods

From September 2007 to August 2012, 17 patients with craniopharyngiomas were experienced 18 surgeries via the keyhole approaches by senior authors in our department. All these clinical files and surgical procedures were studied retrospectively (Table 1). Patients’ age ranged from 16 to 74 years old with a mean age of 48.71 years old. There were 7 males and 10 females. The prominent symptoms were headache (in 9 cases) and⁄or dysfunction of visual acuity and visual field (in 10 cases). 3 of them had polydipsia and polyuria concurrently. Amenorrhea occurred in 1 female and sexual disturbance in 1 male respectively. Lesions in 2 patients were found by the health examination occasionally. The postoperative γ–knife procedure was carried on in 1 patient, and another patient received surgery again due to the recurrence of lesion.