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February 5, 2026

Endoscopic Endonasal Approach With Extradural Posterior Clinoidectomy and Upper Clivectomy for Retrochiasmatic Craniopharyngiomas

Key Points

This research aims to evaluate the safety and efficacy of endoscopic endonasal approach with extradural posterior clinoidectomy and upper clivectomy for retrochiasmatic craniopharyngiomas.
Conducted a retrospective analysis of 35 nonelderly patients.
Performed surgical resections using endoscopic endonasal approach with EPC and UC.
Evaluated the efficacy of the surgical methods, including extent of resection and patient outcomes.
Expanded access route for retrochiasmatic region from 9.7 to 19.7 mm.
Achieved gross total resection in 28 patients and near-total in 7.
Visual function improved in 13 patients, with 34 preserving neuropsychological function.
No tumor recurrence in 19 of 20 initial treatment gross total resection patients.

Abstract

BACKGROUND AND OBJECTIVES: The endoscopic endonasal approach (EEA) has been the predominant surgical corridor for the craniopharyngioma in the past decade. Retrochiasmatic craniopharyngiomas pose a more difficult challenge. The narrow space between the tumor and the optic chiasm makes it difficult to have an effective and balanced protocol between aggressive therapy and reducing adverse symptoms. We have developed a meticulous method with extradural posterior clinoidectomy (EPC) and upper clivectomy (UC). Here, we present a series of such patients demonstrating its safety and efficacy. METHODS: Between 2016 and 2022, we resected 35 consecutive nonelderly patients of retrochiasmatic craniopharyngiomas by using EEA with EPC and UC. We analyzed the efficacy of EPC and UC, and determinants of the extent of resection and outcomes in retrochiasmatic craniopharyngiomas. RESULTS: By adding EPC and UC to the standard EEA, the access route for the retrochiasmatic region has expanded from 9.7 to 19.7 mm. Gross total resection (GTR) was achieved in 28 patients, and near total resection (NTR) in 7. Anterior and posterior pituitary hormone replacement therapy was required in 33 patients at the last follow-up. Visual function status improved in 13 patients, whereas the other 22 patients remained unchanged postoperatively. Neuropsychological function status improved in 1 patient and was preserved in 34 patients. The mean duration of follow-up was 60.1 months. In the initial treatment patients (n = 20), there was no tumor recurrence in 19 GTR patients and 1 NTR patient. In retreatment patients (n = 15), tumor recurrence was detected in 5 of 9 GTR patients and in 2 of 6 NTR patients. CONCLUSION: EEA with EPC and UC for retrochiasmatic craniopharyngioma widens the surgical corridor significantly and offers the advantage to visualize the tumor origin, hypothalamus, and lower surface of the optic chiasm. EPC and UC aid in safe, maximum, and aggressive resection to decrease the tumor recurrence.

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