Extended Endoscopic Endonasal Transplanum and Transdorsum Sellar Approach for the Resection of Retroinfundibular Craniopharyngioma with Two-Piece Dural Opening: A Technical Case Report

Abstract Background The surgical treatment of retroinfundibular craniopharyngiomas is challenging due to their location and the surrounding neurovascular structures. In this report, the transdorsum sellae approach with posterior clinoidectomy, the efficacy of direct cyst puncture and the suitability of a two-piece dural opening are presented. Case Description: A 56-year-old male with visual and cognitive disturbances was referred to our hospital. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a mostly cystic lesion with calcifications in the suprasellar and retroinfundibular areas. The imaging findings were suspected craniopharyngioma, and an extended endoscopic endonasal transdorsum sellar approach with posterior clinoidectomy was performed for direct access to the lesion. Two pieces of the dura were opened to prevent postoperative CSF leakage. The patient’s postoperative course was uneventful. Conclusions The endoscopic transdorsum sella approach gives direct access to the posterior cranial fossa. Direct puncture of the cyst without CSF drainage is helpful for large cystic lesions. A two-piece dural opening is easy to suture and can reduce the chance of postoperative CSF leakage.

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