Preoperative MRI of type Q craniopharyngioma in a child. (a) Coronal view showing that the tumor is located beneath the diaphragma sellae and the optic chiasm is pushed upward; the bilateral cavernous sinuses are not involved. (b) Sagittal view showing that the pituitary fossa is enlarged; the pituitary gland and pituitary stalk are unrecognizable. The tumor protrudes into the anterior skull base, and the bottom of the third ventricle is pushed by the tumor
This is a case of Q-type craniopharyngioma in a child, and the origin was located beneath the diaphragma sellae. Therefore, the transsphenoidal approach could well treat the origin of the tumor. Although the tumor had reached the level of the third ventricle floor, diaphragma sellae and arachnoid remained between the tumor and important structures, providing a natural interface for separation.
The tumor protruded into the anterior skull base through the anterior chiasm space, and transcranial surgery could also achieve satisfactory resection through the anterior chiasm space. However, the patient’s pituitary fossa was deepened, and the transcranial approach was blocked by tuberculum sellae, which rendered it difficult to expose the tumor’s origin. Tuberculum sellae had to be removed to achieve satisfactory exposure.
This is also a Q-type tumor. Compared with Case 1, the tumor in this case expanded more toward the third ventricle. Although some tumors protrude into the space of the third ventricle, there remain multiple layers of tumor and the third ventricle floor. Membrane structure was the anatomical basis for the complete preservation of the third ventricle floor in this patient. Some of the tumors are mainly cystic. When removing the tumor, it should not be separated piece by piece but in an en bloc pattern, otherwise tumor tissue will be easily missed.