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Amin B. Kassam, Paul A. Gardner, Carl H. Snyderman, Ricardo L. Carrau, Arlan H. Mintz and Daniel M. Prevedello

Evolution of the Endonasal Approach for Craniopharyngiomas The evolution of the TSA has resulted from technological developments, increasing anatomical understanding, and collaboration between otolaryngology and neurosurgery. Key technology platforms, namely neuronavigation, high-speed electric drills, extendable microinstrumentation, endonasal ultrasonic aspiration, reconstructive materials, and improved endoscope optics, have allowed the further extension of transsphenoidal techniques into a fully endoscopic transnasal approach for lesions that are

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Paul A. Gardner, Daniel M. Prevedello, Amin B. Kassam, Carl H. Snyderman, Ricardo L. Carrau and Arlan H. Mintz

The Early Years of Craniopharyngioma Treatment The first reported successful resection of a craniopharyngioma via a transsphenoidal route was accomplished by Albert E. Halstead in 1909. 26 Halstead used the infranasal route proposed by Allen Kanavel, who worked with him at Northwestern University in Chicago. Prior to this operation, all other transnasal approaches were performed via the upper part of the nasal cavity through the face. 15 Five months later, William Mixter and Alexander Quackenboss, both from Boston, Massachusetts, drained a cystic

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Paolo Cappabianca, Luigi M. Cavallo, Felice Esposito and Enrico De Divitiis

Editorial “Craniopharyngiomas: transsphenoidal method of approach—for the virtuoso only?” is the title of the Ciric and Cozzens' 2 presentation at the Congress of Neurological Surgeons meeting in Las Vegas, Nevada, in 1979. This question does not seem true but rather rhetorical, which is confirmed by the reasons reported by the authors. Coming almost 30 years later, the article by Gardner et al.—while observing the evolution of the technique, which is not limited as before to sellar lesions with suprasellar extension (preferably infradiaphragmatic or

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Paul A. Gardner, Amin B. Kassam, Carl H. Snyderman, Ricardo L. Carrau, Arlan H. Mintz, Steven Grahovac and Susan Stefko

T he microscopic, transsphenoidal approach for the resection of certain craniopharyngiomas is well established and generally accepted, 6 , 13–15 , 17 , 20–24 , 29 , 30 and there are several studies comparing this approach with a transcranial approach. 21 , 24 , 30 Although the transsphenoidal approach is traditionally limited to predominantly sellar lesions with secondary suprasellar extension, 23 the development and application of the “extended approach” have provided greater access to suprasellar lesions. 17 , 20 , 25 Despite this modification

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Jose M. Pascual

T o the E ditor : We read with great interest the article by Kassam et al. (Kassam AB, Gardner PA, Snyderman CH, et al: Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108: 715–728, April, 2008). The authors showed the unparalleled possibilities provided by the expanded transsphenoidal approach in combination with endoscope-assisted technology in achieving total and safe resection of craniopharyngiomas that have a

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Liangxue Zhou and Chao You

T o T he E ditor : We read with great interest the article by Kassam et al. (Kassam AB, Gardner PA, Snyderman CH, et al: Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108: 715–728, April 2008), who reported on a new classification of craniopharyngioma based on the infundibulum. The authors must be congratulated on their subtle observations and diligent work, which provided a new classification of

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Luigi M. Cavallo, Daniel M. Prevedello, Domenico Solari, Paul A. Gardner, Felice Esposito, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam and Paolo Cappabianca

craniopharyngioma, 21 , 32 , 54 , 64 , 71 , 75 , 81 , 83 even though it is not always possible because of the deep location, frequent proximity to vital neurovascular structures, or the desire of the neurosurgeon to avoid major postoperative neurosurgical and neuropsychological impairment. 62 Moreover, despite their benign nature, craniopharyngiomas can recur even after radical surgery, and removal of a recurrent craniopharyngioma is even more challenging than the primary surgery, more often resulting in incomplete resection and a higher risk of death and complications. 5 , 21

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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

Journal of Neurosurgery JNS 0022-3085 1933-0693 American Association of Neurological Surgeons JNS.2010.113.2.1 Paper 744 Integra Foundation Award A Systematic Analysis of Survival Outcomes and Tumor Recurrence in 8,058 Craniopharyngiomas Isaac Yang , MD , Michael Ivan , MD , Derick Aranda , MD , Michael E. Sughrue , MD , and Andrew T. Parsa , MD, PhD (San Francisco, CA) 8 2010 113 2 A429 A429 This is an Open Access article: verbatim copying and redistribution of this article

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Srinivas Chivukula, Maria Koutourousiou, Carl H. Snyderman, Juan C. Fernandez-Miranda, Paul A. Gardner and Elizabeth C. Tyler-Kabara

patients. Pathological Entity Table 2 summarizes the most frequent presenting symptoms of patients with skull base tumors. Although headaches were prominent, occurring in 48.2% of 112 patients with tumors, they were relatively nonspecific to tumor type and therefore were limited in diagnostic utility. Others symptoms such as epistaxis, occurring in 9 (37.5%) of 24 patients with angiofibromas, are more illuminative of underlying pathology. Craniopharyngiomas are similarly associated with endocrinological and visual deficits, and chordomas are associated with CN

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Maria Koutourousiou, Paul A. Gardner, Juan C. Fernandez-Miranda, Alessandro Paluzzi, Eric W. Wang and Carl H. Snyderman

evolving role of transsphenoidal surgery . Adv Tech Stand Neurosurg 33 : 151 – 199 , 2008 4 Cardoso ER , Peterson EW : Pituitary apoplexy: a review . Neurosurgery 14 : 363 – 373 , 1984 5 Cavallo LM , Prevedello DM , Solari D , Gardner PA , Esposito F , Snyderman CH , : Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. Clinical article . J Neurosurg 111 : 578 – 589 , 2009 6 de Divitiis E , Cavallo LM , Esposito F , Stella L , Messina A : Extended endoscopic