The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas.

Abstract

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