OBJECTIVETo investigate the techniques and effect of surgical resection of large intra- and extra-ventricular craniopharyngiomas via anterior interhemispheric trans-lamina terminalis approach.

METHODSFifty-two patients who were surgically treated for large intra- and extra-ventricular craniopharyngiomas were retrospectively analyzed. All patients underwent surgery via anterior interhemispheric trans-lamina terminalis approach. Of the 52 patients, 28 were male and 24 were female, with age ranging from 3 to 67 years (mean age 33.5 years). The maximum tumor diameter varied from 4.0 to 7.8 cm, with mean diameter of 5.1 cm. Contrast-enhanced MRI was underwent to determine the extent of tumor resection on the 1 to 3 months after surgery.

RESULTSTotal removal of the lesion was achieved in 47 cases (90.4%), 5 patients underwent subtotal resection (9.6%). Division of the anterior communicating artery was performed in 6 patients with no early or late complications related to division of the artery. Visual acuity was preserved or improved in 44 patients (84.6%). Preservation of the pituitary stalk were achieved in 33 patients (63.5%). No surgery-related deaths occurred. The postsurgical follow-up period varied from 3 months to 68 months (mean 25.4 months). Twenty-three cases had endocrinological deficit and received some form of hormonal replacement after surgery. Permanent diabetes insipidus occurred in 18 cases. Three patients died and 6 patients suffered recurrence during the followed-up period.

CONCLUSIONSThe anterior interhemispheric approach, with opening of the lamina terminalis, is a valid choice for large intra- and extra-ventricular craniopharyngiomas. These tumors can be removed without significant sequelae related to the surgical approach because optic nerves, optic chiasm, internal carotid artery, hypothalamic structures and pituitary stalk can be seen and effectively protected.