The Endoscopic Endonasal Approach to Suprasellar Craniopharyngioma

Craniopharyngiomas (CP) are rare benign tumors located in close proximity to critical intracranial structures, presenting significant surgical challenges for neurosurgeons. Novel surgical strategies prioritize maximizing resection while optimizing functional outcomes. Both transcranial and transsphenoidal approaches are introduced using similar microsurgical principles to consider the potential adherence of these tumors to surrounding neurovascular structures while respecting the arachnoid planes by sharp extracapsular dissection. The endoscopic endonasal approaches (EEA) have recently evolved through comprehensive cadaveric studies and the introduction of advanced endoscopic cameras and long-shaft equipment. These innovations have not only facilitated basic surgical goals in CP cases but have also enabled the management of complex CP, including those located in the suprasellar region. The extended endoscopic endonasal transplanum/transtuberculum approach offers panoramic visualization of a wide area of the ventral skull base, spanning from the interpeduncular fossa to the posterior ethmoid sinus, thus providing optimal access to the suprasellar region. This enhanced exposure near the critical structures such as perforating arteries, the hypothalamic-pituitary axis, and the optic apparatus contributes to superior surgical outcomes in endoscopic endonasal resection of the suprasellar CP compared to transcranial approaches. Classification of the suprasellar CP based on a tumor-stalk relationship provides a detailed anatomic roadmap, allowing for customized bony and dural openings. This chapter further discusses the most practical classification to guide the surgical precision in suprasellar CP.