• Ricky H Wong, Kenneth De Los Reyes, Puya Alikhani, Sananthan Sivaknathan, Jamie van Gompel, Harry van Loveren, and Siviero Agazzi.
• ‡Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida; §Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California; ¶Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
• Neurosurgery. 2015 Aug 18.

BackgroundRetrochiasmatic, retroinfundibular craniopharyngiomas are surgically challenging tumors. Anterolateral, posterolateral, and endoscopic endonasal approaches represent the most commonly used techniques to access these tumors, but all require an extensive exposure time, and each has its own risks and limitations. The subtemporal approach is a well-known neurosurgical approach that is rarely described for craniopharyngiomas.ObjectiveTo assess the feasibility, advantages, and disadvantages of a subtemporal approach for craniopharyngiomas.MethodsFive patients with retrochiasmatic craniopharyngiomas where the majority of the tumor extended behind the dorsal clival line underwent a subtemporal approach for resection. Extent of resection, degree of temporal lobe injury, visual and endocrine outcomes, and time to recurrence were analyzed.ResultsAverage tumor volume was 6.4 cm. Near-total resection was achieved in 80% (4/5) and subtotal in 20% (1/5). All patients had stable or improved vision. There was 1 new permanent endocrine deficiency. Minimal temporal lobe edema was observed in 80% (4/5) of patients. Three patients required postoperative radiation.ConclusionThe subtemporal approach represents a feasible approach for retrochiasmatic, retroinfundibular craniopharyngiomas when gross total resection is not mandatory. It provides rapid access to the tumor and a caudal-to-cranial visualization that promotes minimal manipulation of critical neurovascular structures, particularly the optic apparatus.AbbreviationDCL, dorsal clival line.

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