Endoscopic endonasal pituitary transposition trans-tuber-cinereum for resection of the third ventricle craniopharyngioma

Endoscopic endonasal approach (EEA) to craniopharyngioma has been widely used in the last decade. However, intrinsic third ventricle craniopharyngioma is still a difficult type for EEA. Endoscopic endonasal suprachiasmatic trans-lamina terminalis approach is an alternative solution. In consideration of the origin of intra-third ventricle craniopharyngioma is tuberoinfundibular area in the floor of the third ventricle, the suprachiasmatic translamina terminalis approach is limited in exposing this area from anterior-superior direction. In this technical note, we describe our surgical technique for resection of the third ventricle craniopharyngioma by using endoscopic endonasal pituitary transposition trans-tuber-cinereum approach. The surgical technique includes posterior clinoidectomy, pituitary transposition, and opening the tuber cinereum. This described approach was performed in two patients with intrinsic third ventricle craniopharyngiomas, both of them achieved gross total resection. Transient pituitary deficiency was replaced with hormones. No other complications were occurred. Endoscopic endonasal pituitary transposition trans-tuber-cinereum approach is a safe and effective for this special type of craniopharyngioma.