Introduction: Bifrontal flap unilateral interhemispheric approach to peri-chiashmatic craniopharyngioma is a noble approach to most central craniopharyngiomas. This approach is a more inter-hemispheric than the classical fronto-basal approach and preserves most of the polar bridging veins as well as both the olfactory tracts.
Methods: Bifrontal flap unilateral interhemispheric approach was used to operate the peri-chiashmatic craniopharyngioma in 14 number of patients. Bifrontal flap unilateral interhemispheric approach was designed to provide a wide operative field, better orientation and views of important neural structures & perforating arteries. Moreover, the preservation of pituitary stalk is linked well with postoperative pituitary function. When the Anterior Communicating Artery (ACoA) restricted the operative exposure, the artery was divided safely after assessing the calibers of both the Anterior Cerebral Artery(ACAs).
Results: Since 2014, we operated 14 patients using this approach to achieve total or near-total excision of predominantly central craniopharyngiomas. The A-Com Artery was divided in 6 of 14 patients with retro & pre chiasmatic tumors with no early or late complications related to division of the artery. Eleven cases were operated from right inter-hemispheric side and three were operated from the left side, decided by the absence of major cortical sagittal veins. We achieved visual improvement in 60% cases and preservation of the pituitary stalk was achieved in 70% of patients. There was no operative mortality.
Conclusions: flap unilateral interhemispheric approach allowed adequate wide operative field with better orientation and views of important neural structures & perforating arteries without requiring combination with other approaches. Moreover, preservation of the pituitary stalk linked well with postoperative pituitary function.
Patient Care: This is a new surgical approach, which improves the extent of tumor excision with preservation of the normal structure in around peri-chiasmatic craniopharyngiomas.
Learning Objectives: Bifrontal flap unilateral interhemispheric approach allowed adequate wide operative field with better orientation and views of important neural structures and perforating arteries without requiring combination with other approaches. Moreover, preservation of the pituitary stalk linked well with postoperative pituitary function.