Fully Endoscopic Minimally Invasive Trans-Eyebrow Supraorbital Translaminar Approach to Third Ventricle Craniopharyngiomas: Technical Nuances and Stepwise Illustrative Description

Mehdi Khaleghi; Kyle C Wu; Daniel M Prevedello

doi:10.1016/j.wneu.2024.03.095

Fully Endoscopic Minimally Invasive Trans-Eyebrow Supraorbital Translaminar Approach to Third Ventricle Craniopharyngiomas: Technical Nuances and Stepwise Illustrative Description

World Neurosurg. 2024 Mar 24:186:78-86. doi: 10.1016/j.wneu.2024.03.095. Online ahead of print.

Authors

Mehdi Khaleghi¹, Kyle C Wu¹, Daniel M Prevedello²

Affiliations

¹ Department of Neurosurgery, The James Cancer Center Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
² Department of Neurosurgery, The James Cancer Center Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA. Electronic address: daniel.prevedello@osumc.edu.

PMID: 38522791
DOI: 10.1016/j.wneu.2024.03.095

Abstract

Background: Traditional microsurgical approaches for addressing intraventricular craniopharyngioma provide limited access to the retrochiasmatic area and tumors with significant lateral or rostrocaudal extensions. Extended endoscopic endonasal approaches can effectively overcome many of limitations, yet they require a favorable working angle between the optic chiasm and pituitary gland, as well as the involvement of the third ventricle floor by the tumor.

Methods: Herein, the authors describe the surgical nuances of a keyhole technique for resecting third ventricle craniopharyngiomas via a fully endoscopic minimally invasive trans-eyebrow supraorbital translaminar approach (ESOTLA). A case description detailing the key surgical steps and application of the approach is provided, along with a series of cadaveric photographs to highlight the relevant anatomy and step-by-step dissection process.

Results: The patient is a 44-year-old man who presented with polyuria, low urine specific gravity, and panhypopituitarism. Brain magnetic resonance imaging revealed a solid-cystic heterogeneous-enhanced retrochiasmatic mass within the third ventricle, consistent with craniopharyngioma. A 1-stage ESOTLA was indicated based on the narrow pituitary-chiasm angle and the high functional status of the patient. Near-total resection was achieved, and no new postoperative neurologic or endocrine change was observed. Targeted therapy was implemented based on the histologic result, and the most recent surveillance magnetic resonance imaging showed no evidence of the residual tumor.

Conclusions: By combining a keyhole approach with variable-angle endoscopic visualization through a smaller bony and soft tissue exposure, ESOTLA can provide enhanced illumination within the third ventricle, potentially addressing cosmetic concerns and limited exposure area/angle of freedom associated with its conventional microsurgical counterpart.

Keywords: Endoscopic endonasal approach; Endoscopic translaminar approach; Hypothalamus; Intraventricular craniopharyngioma; Lamina terminalis; Minimally invasive trans-eyebrow supraorbital approach; Suprasellar tumors; Third ventricle.