Abstract:
Objective To evaluate the clinical application of the endoscopic occipital transtentorial transrecess approach (EOTT-TR) for craniopharyngiomas within the third ventricle.
Methods A 54-year-old female patient presented with progressive visual impairment and headache for six months. Endocrine evaluation indicated mild impairment of the pituitary-hypothalamic axis function. Imaging revealed a large solid tumor entirely confined within the third ventricle, 4.7 cm in maximal diameter.The lesion was resected via right EOTT-TR, which involved upward retraction of the pineal gland under the 3D endoscopy, and through the pineal recess to access the third ventricle. Following resection, pathological diagnosis was performed, and postoperative complications were observed.
Results Subtotal resection was achieved. Postoperatively, central diabetes insipidus, diplopia and upward gaze dysfunction occurred, but improved after 3 months of follow-up. MRI confirmed subtotal resection of the tumor, the vision of the patient was improved, and the Karnofsky performance status (KPS) score increased from 80 points to 90 points 3 months after operation. The pathological diagnosis was papillary craniopharyngioma (WHO grade Ⅰ).
Conclusion The EOTT-TR provides a unique posterior-superior to anterior-inferior trajectory that optimally exposes the entire third ventricle, particularly the anterior-inferior wall where craniopharyngiomas commonly originate. It enables safe resection while preserving hypothalamic and optic function, representing a safe, feasible, and anatomically advantageous minimally invasive approach for strictly intraventricular craniopharyngiomas.
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