Craniopharyngioma
Everything in the library about craniopharyngioma — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
3 items
Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...
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As a part of the Pediatric Endoscopic Neurosurgery 2018 Course, Dr. Jeffrey Greenfield discusses the relevance of skull base surgery to pediatric neurosurgery. He focuses on the continuum of endoscopy, age specific considerations, categoriz
video21:33 · Sep 2018
Endoscopic Assist for Pediatric Tumors, Vascular, and Hydrocephalus:...
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As a part of the Pediatric Endoscopic Neurosurgery 2018 Course, Dr. Gerald Grant discusses endoscopy in the treatment of pediatric tumors, vascular cases, and hydrocephalus. He further details endoscopic assist versus endoscopic controlled,
video20:32 · Sep 2018
Minimally Disruptive Subcortical Neurosurgery in Children - Concepts of the...
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As a part of the Pediatric Endoscopic Neurosurgery 2018 Course, Dr. Erin Keihna discusses the minimally disruptive subcortical neurosurgery in children. She further details the available surgical options for subcortical lesions and intraven
video21:32 · Sep 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...
The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal.
clinicalGreenfield0:00 ↗
Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium.
clinicalGreenfield7:00 ↗
Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches.
clinicalGreenfield7:00 ↗
Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects.
clinicalGreenfield7:00 ↗
Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure.
clinicalGreenfield7:00 ↗
The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults.
clinicalGreenfield7:00 ↗
In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy.
clinicalGreenfield7:00 ↗
The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice.
clinicalGreenfield11:40 ↗
Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations.
clinicalGreenfield11:40 ↗
Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection.
clinicalGreenfield11:40 ↗
A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique.
clinicalGreenfield11:40 ↗
The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach.
clinicalGreenfield11:40 ↗
In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery.
clinicalGreenfield11:40 ↗
One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak.
clinicalGreenfield11:40 ↗
The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque.
clinicalGreenfield11:40 ↗
For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging.
clinicalGreenfield11:40 ↗
Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case.
clinicalGreenfield11:40 ↗
The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges.
clinicalGreenfield16:25 ↗
The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases.
clinicalGreenfield18:29 ↗
There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces.
clinicalGreenfield18:29 ↗
Endonasal equipment and scopes are designed to work in very small spaces and work well in the pediatric nose; while it is a little tighter, it is not so tight that cases cannot be done, and the practice has never had to avoid using an instrument because the nose was too small.
clinicalSchwartz19:30 ↗
Application-specific equipment and scope technology for endoscopic neurosurgery has evolved to meet demands, with the armamentarium for skull base work being distinctly different from that used for intraventricular work.
host_summary20:01 ↗
Endoscopic Assist for Pediatric Tumors, Vascular, and Hydrocephalus:...
Endoscopic-assist uses the endoscope to augment visualization during microscopic craniotomy, whereas endoscopic-controlled uses the endoscope as the sole visualization (e.g., transnasal pituitary).
clinicalJerry Grant0:33 ↗
A rigid endoscope holding arm is necessary for endoscopic-assist cases to free the surgeon's hands and maintain spatial awareness in the limited craniotomy field.
clinicalJerry Grant2:31 ↗
Rigid scopes are preferred over flexible scopes in endoscopic-assist settings due to superior optics and lower risk of damage during extraction.
opinionJerry Grant3:00 ↗
Insertion and removal of the endoscope are the riskiest phases; the surgeon must watch the scope under the microscope rather than the endoscopic screen to avoid injury to the frontal lobe, olfactory nerves, optic chiasm, or carotid.
clinicalJerry Grant3:30 ↗
Spatial awareness is critical in endoscopic-assist because the surgeon cannot see behind the scope; structures posterior to the scope tip are invisible.
clinicalJerry Grant4:30 ↗
Angled rigid scopes (30° and 70°) allow visualization around corners and beneath structures (e.g., optic chiasm) that would otherwise require retraction or repositioning.
clinicalJerry Grant7:00 ↗
For sellar/suprasellar craniopharyngiomas, approach selection (transnasal vs. cranial) depends on patient age, sphenoid ossification, nares size, and pituitary function.
clinicalJerry Grant8:00 ↗
Endoscopic assist from a subfrontal or transciliary approach can reproduce the view obtained transnasally, allowing visualization beneath the optic chiasm and into the third ventricle.
clinicalJerry Grant9:00 ↗
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