Fronto-basal interhemispheric approach for craniopharyngiomas extending outside the suprasellar cistern

Objective: The aim of the present study was to establish the usefulness of the fronto-basal approach with a relatively small craniotomy window for the removal of tumors protruding from the sellar-suprasellar region to the third and basal cistern. Method: Forty-two patients who were surgically treated for craniopharyngiomas extending outside the sellar-suprasellar region were evaluated. All the patients were operated on by the fronto-basal interhemispheric approach, and the average follow-up period was 5 years. Results: Gross total resection of the lesion was achieved in 30 cases. Eight patients underwent subtotal resection and four patients underwent partial removal due to recurrence after previous surgeries with or without radiotherapy. In the immediate postoperative period, major complications, including impairment of the cranial nerves, were observed in two cases. One patient exhibited transient memory disturbance due to infarction of the perforator; after 3 months, this symptom was ameliorated. Three of the patients died during follow-up; however, 6 of the 30 undergoing gross total removal and 10 of the 12 patients undergoing subtotal or partial removal suffered regrowth. Ultimately, a total of 12 patients underwent re-operation with the same approach or combined with the orbito-zygomatic approach. Conclusion: In our experience, the fronto-basal interhemispheric approach, even through a small craniotomy window, is a valid choice for the removal of craniopharyngiomas extending outside the sellar-suprasellar region. Using this approach, tumors can be removed without significant sequelae related to surgical technique due to easy preservation of the pituitary stalk, hypothalamic structures, and perforators. This approach offers a safe and minimally invasive means of treating craniopharyngiomas.