Abstract
The transnasal-transsphenoidal approach is the first choice in treating infradiaphragmatic craniopharyngiomas with sellar enlargement and a rounded and symmetrical suprasellar extension. The important points to consider when using the transsphenoidal surgical approach in treating infradiaphragmatic craniopharyngiomas are discussed, based upon our experience with 25 patients. A transsphenoidal surgical procedure with a straight incision of the normal pituitary gland horizontally and sharply can avoid any major functional damage to the anterior pituitary gland. It is also extremely important to completely remove calcification piece by piece to prevent CSF leakage during removal of the tumor. The severe CSF leakage after total tomor resection is prevented by infiltrating of a piece of thigh-muscle and some fatty tissue into the sella and then reconstructing the sellar floor with vomer or sellar plate and ensuring lumber drainage. The concept of a subtotal tumor excision to preserve pituitary function, which avoids damage to the hypothalamic structures and limits CSF leakage, especially when treating childhood infradiaphragmatic craniopharyngiomas, seems justified. With the advances in surgical technique, intraoperative monitoring and surgical devices, the transnasal surgical results for treating infradiaphragmatic craniopharyngiomas can be continuously improved.
