The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas

Abstract

Objective: We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique.

Methods: Four cadaveric specimens fixed with gluteraldehyde and injected with latex were dissected to illustrate the approach.

Results: The surgical steps of the approach are reported. The ACoA anatomy was studied. In particular, the surgical route in-between and lateral to the first and second segments of the anterior cerebral artery and the ACoA complex were examined. The approach was adopted in a clinical setting; two illustrative cases regarding the removal of large craniopharyngiomas with suprasellar extension through this route are described.

Conclusions: The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas.

Keywords: A1; A2; ACoA; Anterior communicating artery; Craniopharyngiomas; FTO; First segment of the anterior cerebral artery; Frontotemporo-orbital; Interhemispheric approach; MRI; Magnetic resonance imaging; SD; Second segment of the anterior cerebral artery; Standard deviation; Translaminaterminalis.