Transcavernous Sinus Transtuber Cinereum Approach for Pure Third Ventricle Craniopharyngioma Resection.

BACKGROUND AND

OBJECTIVES

Craniopharyngiomas confined to the third ventricle present formidable surgical challenges owing to their deep location and proximity to critical neurovascular structures. This study evaluates the transcavernous sinus transtuber cinereum (TCSTC) approach, a technically advanced route that enables direct access to the third ventricle while preserving surrounding anatomy.

METHODS

Ten cadaveric heads were meticulously prepared with vascular injections, and the right side was dissected under magnification using a surgical microscope. High-resolution imaging and digital caliper measurements were used to define a safe entry zone through the tuber cinereum. The anatomic window was delineated between the mammillary bodies and pituitary stalk insertion. In the clinical setting, 5 patients with pure intraventricular craniopharyngiomas were treated using a pretemporal craniotomy combined with a partial medial transcavernous approach. The surgical outcomes and postoperative complications were reviewed.

RESULTS

Cadaveric dissections confirmed that the TCSTC approach provides a consistent and safe anatomic corridor to the third ventricle, with a mean safe entry width of 8.2 mm (range 7.15-8.85 mm). This approach facilitates optimal visualization of the interpeduncular fossa, mammillary bodies, and basilar tip perforators. In all 5 clinical cases, gross total resection was achieved without any intraoperative complications. Postoperative outcomes included transient diabetes insipidus in 2 patients and long-term hormone replacement therapy in 3 patients. No cerebrospinal fluid leaks, infections, or recurrences were observed at the latest follow-up.

CONCLUSION

The TCSTC approach is a safe and effective strategy for resection of pure intraventricular craniopharyngiomas. It offers enhanced anatomic visualization while minimizing hypothalamic and vascular injuries. With appropriate technical execution, maximal tumor removal with low morbidity is possible. Further validation using larger series and long-term follow-up is warranted.