The best chance of curing craniopharyngio
ma is achieved by
microsurgical total resection; however, its location adjacent to critical structures hinders co
mplete resection without neurologic deterioration. Unrecognized residual tu
mor within
microscopic blind spots
might result in tu
mor recurrences. To i
mprove outco
mes, new techniques are necessary to visualize tissue within these blind spots. We exa
mined the success of hybrid
microscopic-endoscopic neurosurgery for craniopharyngio
ma in a neurosurgical suite.
Methods
Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously.
Results
Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery.
Conclusions
Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma.