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Toshihiro Yasui, Akira Hakuba, Soo Han Kim and Shuro Nishimura

technique. Surg Neurol 26: 271–276, 1986 2. Hakuba A , Nishimura S , Inoue Y : Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24 : 405 – 415 , 1985 Hakuba A, Nishimura S, Inoue Y: Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24: 405–415, 1985 3. Jefferson G : Trigeminal neurinomas with some remarks on malignant invasion of the Gasserian ganglion

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Total removal of craniopharyngiomas

Approaches and long-term results in 144 patients

M. Gazi Yaşargil, Marijan Curcic, Mirjana Kis, Gertrud Siegenthaler, Peter J. Teddy and Peter Roth

: Brain tumors of disordered embryogenesis in adults , in Youmans JR (ed): Neurological Surgery , ed 2 . Philadelphia : WB Saunders , 1982 , Vol 5 , pp 2899 – 2935 Cobb CA, Youmans JR: Brain tumors of disordered embryogenesis in adults, in Youmans JR (ed): Neurological Surgery, ed 2. Philadelphia: WB Saunders, 1982, Vol 5, pp 2899–2935 12. Hakuba A : The transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas , in Samii M (ed): Surgery In and

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Harold J. Hoffman, Marcia De Silva, Robin P. Humphreys, James M. Drake, Mary Lou Smith and Susan I. Blaser

patients had sellar tumors that did not distort the optic nerves or surrounding vessels but did enlarge the sella turcica. Fig. 2. Left: Preoperative magnetic resonance (MR) image showing a prechiasmatic craniopharyngioma extending into the sella. Right: Postoperative MR image of the same patient after total removal of tumor with tension relieved from the optic nerves. Fig. 3. Magnetic resonance image showing a large cystic retrochiasmatic craniopharyngioma filling the third ventricle and producing hydrocephalus. Note the differing intensities

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Wesley A. King, Keith L. Black, Neil A. Martin, Rinaldo F. Canalis and Donald P. Becker

craniopharyngiomas. Surg Neurol 24 : 405 – 415 , 1985 Hakuba A, Nishimura S, Inoue Y: Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24: 405–415, 1985 9. Heros RC : Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64 : 559 – 562 , 1986 Heros RC: Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 64: 559–562, 1986 10. Hitselberger WE , House WF

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Kazuhiko Fujitsu, Tsunemi Sekino, Katsumi Sakata and Takashi Kawasaki

14 : 345 – 351 , 1992 Fujitsu K, Saijo M, Aoki F, et al: Cranio-nasal median splitting for radical resection of craniopharyngioma. Neurol Res 14: 345–351, 1992 5. Hakuba A , Nishimura S , Inoue Y : Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24 : 405 – 415 , 1985 Hakuba A, Nishimura S, Inoue Y: Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24: 405

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Masato Shibuya, Masakazu Takayasu, Yoshio Suzuki, Kiyoshi Saito and Kenichiro Sugita

main structures limiting operative exposure of retrochiasmatic craniopharyngiomas in the anterior interhemispherical approach ( Fig. 2 left ). Although we always try to preserve the artery, dividing it often provides a much wider operating space, which subsequently makes the operation easier and safer ( Fig. 2 right ). When the artery is left intact, it may inadvertently be damaged during retraction of the hemispheres, especially in pediatric cases in which one encounters thin-walled arteries. The ACoA is occluded with small vascular clips and incised between the

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Volker Seifert and Dietmar Stolke

. Giannotta SL , Maceri DR : Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69 : 461 – 466 , 1988 Giannotta SL, Maceri DR: Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69: 461–466, 1988 7. Hakuba A , Nishimura S , Inoue Y : Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg

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therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24 : 405 – 415 , 1985 Hakuba A, Nishimura S, Inoue Y: Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24: 405–415, 1985 3. Malis LI : Surgical resection of tumors of the skull base , in Wilkins RH , Rengachary SS (eds): Neurosurgery. New York : McGraw-Hill , 1985 , Vol 1 , pp 1011 – 1021 Malis LI: Surgical resection of tumors of the skull base, in Wilkins RH

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J. Diaz Day, Takanori Fukushima and Steven L. Giannotta

. J Neurosurg 69 : 461 – 466 , 1988 Giannotta SL, Maceri DR: Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms. Technical note. J Neurosurg 69: 461–466, 1988 12. Hakuba A , Nishimura S , Inoue Y : Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24 : 405 – 415 , 1985 Hakuba A, Nishimura S, Inoue Y: Transpetrosal-transtentorial approach and its application in the therapy of

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Rudolf Fahlbusch, Jürgen Honegger, Werner Paulus, Walter Huk and Michael Buchfelder

The surgical management of 168 consecutive patients harboring craniopharyngiomas treated between January 1983 and April 1997 is described. In 148 patients undergoing initial (primary) surgery, the pterional approach was most frequently used (39.2%) followed by the transsphenoidal approach (23.6%). For large retrochiasmatic craniopharyngiomas, the bifrontal interhemispheric approach was used increasingly over the pterional approach and led to improved surgical results. Total tumor removal was accomplished in 45.7% of transcranial and 85.7% of transsphenoidal procedures. The main reasons for incomplete removal were attachment and/or infiltration of the hypothalamus, major calcifications, and attachment to vascular structures. The success rate in total tumor removal was inferior in the cases of tumor recurrence. The operative mortality rate in transcranial surgery was 1.1% in primary cases and 10.5% in cases of tumor recurrence. No patient died in the group undergoing transsphenoidal surgery. The rate of recurrence-free survival after total removal was 86.9% at 5 years and 81.3% at 10 years. In contrast, the 5-year recurrence-free survival rate was only 48.8% after subtotal removal and 41.5% after partial removal. Following primary surgery, the actuarial survival rate was 92.7% at 10 years, with the best results after complete tumor removal. At last follow up, 117 (79%) of 148 patients who underwent primary surgery were independent and without impairment.

Total tumor removal while avoiding hazardous intraoperative manipulation provides favorable early results and a high rate of long-term control in craniopharyngiomas.