case_images: PMC10849817_01
case_images: Preoperative CT and MRI. (A-C) Preoperative CT and MRI imaging demonstrates the cystic lesion with calcifications suprasellar and retroinfundibular region. (D-F) Gadolinium-enhanced MRI shows a slightly heterogeneously enhanced area within the lesion, which was compressing the optic chiasm, third ventricle, and brainstem
case_images: cureus-0016-00000051850-i01.jpg
case_images: PMC10849817_01_cureus-0016-00000051850-i01.jpg
case_images: FIG1
case_images: Preoperative CT and contrast-enhanced MRI demonstrated a cystic lesion with a maximum diameter of 48 mm and calcifications in the suprasellar and retroinfundibular areas (Figure 1A-1F).
case_images: Intraoperative findings. (A-C) Dorsum sellae and posterior clinoid removal. (A) Dorsum sellae and posterior clinoid detached from the attachments. (B) Removal of the posterior clinoid process. (C) Exposure of the planum, sellae, and clival dura after complete bone removal. (D) A small incision was made on the clival dura for a direct cyst puncture (black arrow). (E) Then, a linear dural incision was made from the planum sphenoidale until the sellar floor. Suturing of the SIS for hemostasis and dural tenting was performed to expand the surgical window. (F, G) Tumor removal. (F) The tumor capsule was meticulously dissected from the optic chiasm, pituitary stalk, pSHA, and (G) Pcom and perforating arteries and vital neurovascular structures. (H) The incision of the clival dura (white arrow) has been extended to remove the tumor from the prepontine cistern. (I) Detachment of the tumor capsule from neurovascular structures. (J) Indocyanine green fluorescence imaging after resection of craniopharyngioma. The white arrow indicates the pSHA Cb, the black arrow indicates the pSHA Ib, and the asterisk indicates the aTPA. (K) The intraoperative view of the two-piece dural opening after removal of the tumor. The asterisk (*) indicates the reserved dura on the sellar floor and dorsum sellae. The black arrow indicates the clival dura and the white arrow indicates the planum and tuberculum sellae dura. (L) The dural closure using the shoelace suturing technique with a fat graft and collagen matrix. DS: dorsum sellae, PCP: posterior clinoid process, SD: sellar dura, CD: clival dura, SIS: superior intracavernous sinus, PSD: planum sphenoidale dura, T: tumor, PG: pituitary gland, Pcom: posterior communicating artery, PS: pituitary stalk, OCh: optic chiasm, pSHA: primary superior hypophyseal artery, dotted arrow: chiasmatic branch (Cb), arrow: infundibular branch (Ib), P1: posterior cerebral artery, BA: basilar artery, SCA: superior cerebellar artery, aTPA: anterior thalamoperforating artery
case_images: cureus-0016-00000051850-i02.jpg
case_images: PMC10849817_01_cureus-0016-00000051850-i02.jpg
case_images: FIG2
case_images: After the petroclinoid and interclinoid ligaments were detached, a posterior clinoidectomy was performed using grasping forceps (Figure 2A-2E). First, we made a small linear incision on the clival dura (Figure 2D) for direct puncture of the cyst and aspirated fluid content without CSF drainage, as well as performed internal tumor decompression and shrinkage of the laterally extended cystic compartment. The suprasellar portion of the tumor was removed after meticulous dissection from the optic chiasm, the PS, the superior hypophyseal arteries (SHA), and other neurovascular structures (Figure 2E-2G). Then, to remove the tumor from the prepontine cistern, an incision of the clival dura was extended until the dorsum sellae dura (Figure 2H). The tumor was dissected from the perforating arteries and vital neurovascular structures (Figure 2I). Indocyanine green fluorescence imaging (12.5 mg IV) was used to confirm the blood flow of the surrounding arteries and their perforators (Figure 2J). After removal of the tumor, the two-piece dural opening was separately closed with a collagen matrix (DuraGen ; Integra LifeSciences, Plainsboro, NJ, USA), and an abdominal subcutaneous fat graft (Figure 2K-2L) was placed intradurally (an inlay graft) and then continuously sutured with a shoelace technique.
case_images: Surgical nuances of extended endoscopic endonasal transplanum and transdorsum sellar approach for the resection of retroinfundibular craniopharyngioma with two-piece dural opening
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case_images: PMC10849817_01_.jpg
case_images: VID1
case_images: A postoperative CT and MRI with and without gadolinium enhancement demonstrated gross total resection of the tumor (Figure 3A-3D).