Definition

Craniopharyngiomas are also benign lesions of the pituitary and hypothalamic region and make up 1% of intracranial tumors. They occur both in childhood and in adult life. Craniopharyngiomas often show the typical triad with solid tumor, cysts, and calcifications (■ Fig. 22.10).

Chiasmal syndrome is frequently encountered. Surgical therapy of craniopharyngiomas is challenging. Total removal is only accomplished in 50% of cases, and cranio-pharyngiomas tend to recur. Removal is incomplete in the presence of severe hypothalamic involvement and extensive tumor size.

Define Suprsellar

Fig. 22.8. Intra- and suprasellar pituitary macroadenoma with typical lobulated figure-of-eight or "snow man" appearance in sagittal (a) and coronal (b) contrast-enhanced Trweighted MR images

Fig. 22.9. Microscopic transnasal, trans-sphenoidal view of a pituitary adenoma before (a) and after resection (b), exposing the diaphragma sellae

Fig. 22.8. Intra- and suprasellar pituitary macroadenoma with typical lobulated figure-of-eight or "snow man" appearance in sagittal (a) and coronal (b) contrast-enhanced Trweighted MR images

Only 30% of craniopharyngiomas can be removed by a trans-sphenoidal operation, while 70% of craniopha-ryngiomas have to be operated on by craniotomy. A frontolateral or pterional approach is most frequently used.

Some neurosurgeons prefer a bifrontal approach in the presence of major retrosellar extension. Decompression of the optic chiasm is accomplished in the majority of cases. Hence, most patients experience postoperative visual improvement. However, a rate of 10 to 15% of visual deterioration is encountered following transcranial tumor resections.

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Frontolateral Approach

Fig. 22.10. Pre- and postoperative sagittal MR images (a, b) of a cystic craniopharyngioma that was completely removed via a transnasal approach

Optic Radiation
Fig. 22.11. Intracranial space-occupying lesion (ependymoma of the lateral ventricle) displacing the optic radiation laterally

Fig. 22.10. Pre- and postoperative sagittal MR images (a, b) of a cystic craniopharyngioma that was completely removed via a transnasal approach

Hemispheric Tumors

Gliomas, metastases, and ventricular tumors like ependymomas may compromise the dorsal part of the visual system by displacing or infiltrating the optic radiation (■ Fig. 22.11). These lesions are often approached via a craniotomy of the skull in the direct vicinity of the lesion.

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