Name:
10.3171/2026.7.FOCVID2699_vid
Description:
10.3171/2026.7.FOCVID2699_vid
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/fc666a12-7671-4582-ba04-528f9af6e153/videoscrubberimages/Scrubber_82.jpg
Duration:
T00H07M15S
Embed URL:
https://stream.cadmore.media/player/fc666a12-7671-4582-ba04-528f9af6e153
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/fc666a12-7671-4582-ba04-528f9af6e153/13. 26-99.mp4?sv=2019-02-02&sr=c&sig=oiHUESRVy2Hr1pxX7ducjwVN%2BdE%2FBEDloTu9nA9BRlo%3D&st=2026-10-29T01%3A38%3A13Z&se=2026-10-29T03%3A43%3A13Z&sp=r
Upload Date:
2026-10-29T01:43:13.1514307Z
Transcript:
Language: EN.
Segment:0 .
[AUDIO LOGO]
SPEAKER: This video demonstrates endoscopic and nasal transcavernous posterior clinoidectomy with pituitary transposition for resection of a craniopharyngioma. The patient is a 37-year-old male presented with a 3-week history of diplopia. Neurological examination revealed right abducens nerve palsy. Preoperative visual field testing and pituitary function were normal.
SPEAKER: MRI revealed a large, solid suprasellar and a retrosellar lesion. And a CT scan demonstrated a prominent calcified component. The radiological diagnosis was consistent with craniopharyngioma. Due to the obstruction by the pituitary gland, only the suprasellar portion of the tumor could be visualized through the space between the optic chiasm inferiorly and the pituitary gland superiorly.
SPEAKER: Exposure of the retrosellar component required a posterior clinoid process removal and pituitary transposition. The endoscopic endonasal approach is performed. A right-sided, vascularized nasal septal flap is first elevated. Partial resection of the right middle turbinate and ethmoidectomy are performed to improve exposure, followed by posterior nasal septectomy. A reverse flap is then prepared.
SPEAKER: The contralateral nasal mucosa is transected and brought forward along the exposed right-sided cartilage. A wide bilateral sphenoidectomy is completed. This endoscopic view shows the ventral skull base, with extensive sellar and parasellar exposure achieved. Bone overlying the face of the sellae, anterior wall of the right cavernous sinus, and the clival recess is carefully removed.
SPEAKER: The tuberculum sellae is drilled superiorly up to the sphenoid limbus. Full skeletonization of the right paraclinoidal internal carotid artery is completed. Once thinned with the high-speed drill, the bone is carefully peeled with the Kerrison rongeur and removed. The anterior wall of the right cavernous sinus is opened, and we enter the cavernous sinus. Venous bleeding is controlled with intracavernous injection of Surgifoam.
SPEAKER: The inferior hypophyseal artery is identified, coagulated, and transected. Since the bone overlying the anterior wall of the right cavernous sinus and the right upper clivus has been drilled in advance, the right posterior clinoid process was isolated. Pituitary transposition allows the full exposure of the right posterior clinoid process and peels it free from its dural attachment.
SPEAKER: The medial wall of the cavernous sinus remains attached to the pituitary gland during its medial and superior mobilization. The dura covering the prechiasmatic region is then opened. The proximal and distal rings, as well as the diaphragma sellae, are transected.
SPEAKER: Subsequently, the dura of the dorsum sellae and the clivus is incised downward. By displacing the pituitary gland, we achieve full exposure of the tumor located in the interpeduncular and prepontine cisterns. Piecemeal intracapsular debulking of the tumor is performed, including removal of its calcified component.
SPEAKER: As additional space is created through further debulking, the surrounding neural structures are carefully dissected away from the tumor capsule. The capsule is separated from the basilar artery, posterior cerebral artery, superior cerebellar artery, and oculomotor nerve. We sharply dissected the tumor from the pituitary gland and the pituitary stalk with scissors.
SPEAKER: This is the site of the tumor origin. The mammillary bodies, and subsequently, the basilar artery apex come into view. Dissecting the tumor away from the brainstem remains the most challenging step of the procedure. Preserving the arachnoid membranes is critical to protect the brainstem and its perforating arteries.
SPEAKER: Sufficient internal debulking must be performed before dissecting the tumor capsule. The safe plane of dissection is strictly between the tumor capsule and the brainstem arachnoid. Gross-total resection of the tumor is achieved. Complete mobilization of the pituitary gland provides unobstructed surgical access to the entire interpeduncular and prepontine cisterns.
SPEAKER: Skull base reconstruction is performed using a two-layer technique. A DuraGen inlay graft is placed to primarily close the dural defect. This is followed by placement of the vascularized nasoseptal flap, which is secured in position with Surgicel. Finally, pack the sphenoid sinus with iodoform gauze. Postoperative MRI confirmed gross-total resection of the tumor.
SPEAKER: The patient developed a transient diabetes insipidus, which resolved completely within 1 month. His right abducens nerve palsy improved within 1 week postoperatively, and eventually resolved entirely. No other new neurological deficits were noted. A lumbar drain was placed for several days, and then removed. No postoperative cerebrospinal fluid leak was encountered. Pituitary function remained normal postoperatively. The patient finally recovered well.
SPEAKER: The pathological diagnosis was adamantinomatous craniopharyngioma.
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