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Purpose <p>To evaluate the surgical outcomes of the endoscopic endonasal infrachiasmatic approach (EEIA) for intra-third ventricle craniopharyngiomas (IVC) and to define the anatomical limits of tumor resection through this corridor.</p> Methods <p>We retrospectively analyzed 21 cases of IVCs (17 primary and 4 recurrent) who underwent EEIA between 2016 and 2025. Clinical data were obtained from the institution’s database. Surgical outcomes and anatomical limits of tumor resection were examined.</p> Results <p>Gross total resection (GTR) was achieved in 18 cases and subtotal resection (STR) in 3 cases. Among patients with preoperative visual and cognitive impairment, improvements were noted in 69.2% and 88.9%, respectively. Tumor margins extending beyond the anterior suprachiasmatic limit of visualization of the infrachiasmatic corridor (IC), corresponding to the chiasma-clival line (CCL), limited safe dissection. Furthermore, tumor adherence to adjacent vasculature and mammillary bodies represented an additional limitation.</p> Conclusion <p>The EEIA may enable aggressive resection of IVCs while preserving and improving visual and cognitive function. Complete resection is limited by the geometry of the operative corridor and tumor adherence to vital structures. The CCL may serve as a practical marker of the anterior suprachiasmatic limit of the corridor and aid in preoperative planning, particularly in identifying cases that may require alternative or staged approaches.</p>

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Endoscopic endonasal infrachiasmatic approach to intra-third ventricle craniopharyngiomas: surgical outcomes and limits to complete resection

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Rayford Hazunga,
  • Hiroki Morisako,
  • Atsufumi Nagahama,
  • Masaki Ikegami,
  • Boon Seng Liew,
  • Takeo Goto

摘要

Purpose

To evaluate the surgical outcomes of the endoscopic endonasal infrachiasmatic approach (EEIA) for intra-third ventricle craniopharyngiomas (IVC) and to define the anatomical limits of tumor resection through this corridor.

Methods

We retrospectively analyzed 21 cases of IVCs (17 primary and 4 recurrent) who underwent EEIA between 2016 and 2025. Clinical data were obtained from the institution’s database. Surgical outcomes and anatomical limits of tumor resection were examined.

Results

Gross total resection (GTR) was achieved in 18 cases and subtotal resection (STR) in 3 cases. Among patients with preoperative visual and cognitive impairment, improvements were noted in 69.2% and 88.9%, respectively. Tumor margins extending beyond the anterior suprachiasmatic limit of visualization of the infrachiasmatic corridor (IC), corresponding to the chiasma-clival line (CCL), limited safe dissection. Furthermore, tumor adherence to adjacent vasculature and mammillary bodies represented an additional limitation.

Conclusion

The EEIA may enable aggressive resection of IVCs while preserving and improving visual and cognitive function. Complete resection is limited by the geometry of the operative corridor and tumor adherence to vital structures. The CCL may serve as a practical marker of the anterior suprachiasmatic limit of the corridor and aid in preoperative planning, particularly in identifying cases that may require alternative or staged approaches.