Complete extirpation of tumor remains the primary goal of neurosurgeons in treating intracranial craniopharyngiomas. The intimate relationship of these lesions with the structures of the skull base and the difficulties of obtaining adequate operative visualization often make total removal an elusive goal. The authors describe the use of a combined fronto-orbitozygomatic temporopolar craniotomy to maximize the operative corridor and thereby increase the probability of maximum tumor resection without morbidity and mortality. They applied this approach in four children with craniopharyngiomas that involved the sellar and parasellar, third ventricle, cavernous sinus, and interpeduncular fossa regions. The surgical results are summarized with a presentation of pre- and postoperative imaging from two illustrative cases. A detailed description of the operative procedure is provided with a comparison to other previously described surgical approaches.
Michael L. Levy, Larry T. Khoo, J. Diaz Day, Mark Liker and J. Gordon McComb
C. C. Tchoyoson Lim, Anuradha Thiagarajan, Chee Seng Sim, Mark L. Khoo, Thomas P. Shakespeare and Ivan Ng
There have been fewer than 60 cases of malignant teratocarcinosarcoma (TCS) described in the literature, usually arising in the nose and paranasal sinuses. The authors report on a patient who presented with neurological symptoms caused by a frontal lobe TCS, and in whom widespread spinal tumor dissemination developed. In rare cases, TCSs can occur with a predominantly cranial and neurological presentation and spread to the spinal canal.