Modified orbitozygomatic craniotomy for craniopharyngioma resection in children.

Abstract

OBJECT:

In this study, the authors evaluated the efficacy and safety of modified orbitozygomatic craniotomy for resection of craniopharyngioma in children.

METHODS:

A prospective, institutional review board-approved database was retrospectively reviewed for pediatric patients undergoing craniopharyngioma resection performed by a single surgeon.

RESULTS:

Ten patients underwent craniopharyngioma resection surgery between July 2000 and January 2006 (4 girls and 6 boys, ages 1.5-17 years). Nine patients presented to the authors' institution, and 1 patient was referred after surgery and radiation therapy were administered elsewhere. Nine patients presented with visual field deficits (2 with unilateral or bilateral light perception only) and 5 with endocrine dysfunction. Eight patients had large tumors that significantly displaced the optic chiasm and hypothalamus. All patients underwent a modified frontotemporal orbitozygomatic osteotomy in a single piece. The lamina terminalis was opened in 4 patients with third ventricular extension. One patient required a staged transsphenoidal operation to remove residual tumor in the sella turcica, and 1 patient underwent a contralateral subtemporal approach to resect a daughter lesion in the prepontine cistern. Complete radiographic resection was achieved in all patients. Follow-up averaged 55 months (range 12-95 months). Vision was improved in 8 patients and remained stable in 2. All patients had postoperative endocrine dysfunction. One patient experienced transient cranial nerve IV palsy and 1 suffered a small caudate stroke 5 months after surgery without sequelae. Two patients experienced polyphagia and weight gain without other symptoms of hypothalamic dysfunction. There were no other new neurological deficits.

CONCLUSIONS:

Modified orbitozygomatic craniotomy provides excellent exposure of the suprasellar region with minimal brain retraction, allowing complete resection of craniopharyngiomas with good visual and neurological results.

• Authors: Kiarash J Golshani, Kirk Lalwani, Johnny B Delashaw, Nathan R Selden
• Journal: Journal of neurosurgery. Pediatrics (J Neurosurg Pediatr) Vol. 4 Issue 4 Pg. 345-52 (Oct 2009) ISSN: 1933-0715 [Electronic] United States
• PMID: 19795966 (Publication Type: Journal Article)

Topics

• Adolescent
• Child
• Child, Preschool
• Craniopharyngioma (diagnosis, surgery)
• Craniotomy (methods)
• Female
• Follow-Up Studies
• Humans
• Infant
• Male
• Neoplasm, Residual (diagnosis, surgery)
• Neoplasms, Multiple Primary (diagnosis, surgery)
• Orbit (surgery)
• Pituitary Neoplasms (diagnosis, surgery)
• Postoperative Complications (etiology)
• Reoperation
• Retrospective Studies
• Skull Base (surgery)
• Sphenoid Sinus (surgery)
• Treatment Outcome
• Zygoma (surgery)