Supradiaphragmatic retrochiasmatic craniopharyngioma in an 80-year-old patient operated by extended endoscopic endonasal approach:: Case report

Background: The transsphenoidal approach is still the optimal procedure for intrasellar infradiaphragmatic craniopharyngiomas. It is also used by many to treat intrasellar tumors which have a suprasellar extension, especially when there is a cystic component. However, this approach is not routinely performed for supradiaphragmatic ones, which are mostly approached by a trans-cranial route, even if the related morbidity is higher. Endoscopic techniques now allow a better visualization and could permit a widening of indications for the transsphenoidal route to such tumors, especially in older patients. Case Report: We used an extended endonasal endoscopic approach in a 80-year-old man who was diagnosed with a purely supradiaphragmatic craniopharyngioma. Preoperative rapid deterioration of visual function was the primary indication for surgery. Subtotal resection of the tumor was accomplished, as confirmed by intra-operative direct visualization and postoperative MRI. A rapid amelioration of visual function was noted postoperatively. Conclusion: Primary endoscopic endonasal surgery for supradiaphragmatic retrochiasmatic craniopharyngiomas in elderly patients could represent a safer approach associated with a lower operative morbidity when compared to transcranial surgery and better postoperative results when compared to conservative treatments currently used. More cases are needed to quantify the risk of CSF leakage, which is currently the main disadvantage of this procedure.