Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas.

Our experience with the transpetrosal-transtentorial approach to retrochiasmatic craniopharyngiomas is herein reviewed and an operative technique is described. Excellent exposure of the retrochiasmatic and suprasellar regions is gained with a minimal retraction of the temporal lobe and cerebellum. Eight cases of retrochiasmatic craniopharyngiomas that extended into the posterior hypothalamus were operated on utilizing this approach. The operative results were excellent in five patients, good in one, and poor in one. There was one death later. The principal advantage of this technique is that it allows the hypothalamus, even in cases in which the structure is remarkably displaced upwards, the third ventricular walls in cases of the intraventricular extension of the tumor, and the inferior surface of the optic chiasma and nerves to be visualized directly and thus safely preserved.