Child's Nervous System

, Volume 34, Issue 5, pp 871–876 | Cite as

Combined endoscopic approach in the management of suprasellar craniopharyngioma

  • Chandrashekhar E. Deopujari
  • Vikram S. Karmarkar
  • Nishit Shah
  • Ravindran Vashu
  • Rahul Patil
  • Chandan Mohanty
  • Salman Shaikh
Original Paper



Craniopharyngiomas are dysontogenic tumors with benign histology but aggressive behavior. The surgical challenges posed by the tumor are well recognized. Neuroendoscopy has recently contributed to its surgical management. This study focuses on our experience in managing craniopharyngiomas in recent years, highlighting the role of combined endoscopic trans-ventricular and endonasal approach.

Case series

Ninety-two patients have been treated for craniopharyngioma from 2000 to 2016 by the senior author. A total of 125 procedures, microsurgical (58) and endoscopic (67), were undertaken. Combined endoscopic approach was carried out in 18 of these patients, 16 children and 2 young adults. All of these patients presented with a large cystic suprasellar mass associated with hydrocephalus. In the first instance, they were treated with a transventricular endoscopic procedure to decompress the cystic component. This was followed by an endonasal transsphenoidal procedure for excision within the next 2 to 6 days. All these patients improved after the initial cyst decompression with relief of hydrocephalus while awaiting remaining tumor removal in a more elective setting. Gross total resection could be done in 84% of these patients. Diabetes insipidus was the most common postsurgical complication seen in 61% patients in the immediate period but was persistent in only two patients at 1-year follow-up. None of the children in this group developed morbid obesity. There was one case of CSF leak requiring repair after initial surgery. Peri-operative mortality was seen in one patient secondary to ventriculitis.


The patients who benefit most from the combined approach are those who present with raised intracranial pressure secondary to a large tumor with cyst causing hydrocephalus. Intraventricular endoscopic cyst drainage allows resolution of hydrocephalus with restoration of normal intracranial pressure, gives time for proper preoperative work up, and has reduced incidence of CSF leak after transnasal surgery.


Combined endoscopic approach thus gives a unique opportunity to remove these lesions more radically with less morbidity.


Craniopharyngioma Transnasal neuroendoscopy Transventricular neuroendoscopy Suprasellar 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barkhoudarian G, Laws ER (2013) Craniopharyngioma: history. Pituitary 16(1):1–8. CrossRefPubMedGoogle Scholar
  2. 2.
    Baskin DS, Wilson CB (1986) Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg 65(1):22–27. CrossRefPubMedGoogle Scholar
  3. 3.
    Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73(1):3–11. CrossRefPubMedGoogle Scholar
  4. 4.
    Samii M, Bini W (1991) Surgical treatment of craniopharyngiomas. Zentralbl Neurochir 52(1):17–23PubMedGoogle Scholar
  5. 5.
    Matson D, Crigler J (1969) Management of craniopharyngioma in childhood. J Neurosurg 30(4):377–390. CrossRefPubMedGoogle Scholar
  6. 6.
    King TT (1979) Removal of intraventricular craniopharyngiomas through the lamina terminalis. Acta Neurochir 45(3–4):277–286. CrossRefPubMedGoogle Scholar
  7. 7.
    Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108(4):715–728. CrossRefPubMedGoogle Scholar
  8. 8.
    Deopujari CE (2013) Endoscopic management of craniopharyngioma. J Neuro-Oncol 2(1):2–2Google Scholar
  9. 9.
    Katz EL (1975) Late results of radical excision of craniopharyngiomas in children. J Neurosurg 42(1):86–93. CrossRefPubMedGoogle Scholar
  10. 10.
    Raimondi AJ, Rougerie J (1994) A critical review of personal experiences with craniopharyngioma: clinical history, surgical technique and operative results. 1983. Pediatr Neurosurg 21(2):134–150 discussion 151-4CrossRefPubMedGoogle Scholar
  11. 11.
    King TT (1979) Removal of intraventricular craniopharyngiomas through the lamina terminalis. Acta Neurochir 45(3–4):277–286. CrossRefPubMedGoogle Scholar
  12. 12.
    Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90(2):237–250CrossRefPubMedGoogle Scholar
  13. 13.
    Symon L (1985) Radical excision of craniopharyngioma: Results in 20 patients. J Neurosurg 62(2):174–181. CrossRefPubMedGoogle Scholar
  14. 14.
    Patterson RH Jr, Danylevich A (1980) Surgical removal of craniopharyngiomas by the transcranial approach through the lamina terminalis and sphenoid sinus. Neurosurgery 7(2):111–117CrossRefPubMedGoogle Scholar
  15. 15.
    Bhagwati SN, Deopujari CE, Parulekar GD (1990) Lamina terminalis approach for retrochiasmal craniopharyngiomas. Childs Nerv Syst 6(8):425–429CrossRefPubMedGoogle Scholar
  16. 16.
    Yang I, Sughrue ME, Rutkowski MJ, Kaur R, Ivan ME, Aranda D, Barani IJ, Parsa AT (2010) Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 28(4):E5. CrossRefPubMedGoogle Scholar
  17. 17.
    Elliott RE, Wisoff JH (2010) Surgical management of giant pediatric craniopharyngiomas. J Neurosurg Pediatr 6(5):403–416. CrossRefPubMedGoogle Scholar
  18. 18.
    Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O et al (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol 62(4):397–409. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Chandrashekhar E. Deopujari
    • 1
  • Vikram S. Karmarkar
    • 1
  • Nishit Shah
    • 2
  • Ravindran Vashu
    • 1
  • Rahul Patil
    • 1
  • Chandan Mohanty
    • 1
  • Salman Shaikh
    • 1
  1. 1.Department of NeurosurgeryBombay Hospital Institute Of Medical Sciences (BHIMS)MumbaiIndia
  2. 2.Department of ENTBombay Hospital Institute Of Medical Sciences (BHIMS)MumbaiIndia

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