|
The patient a boy 9 years age started to complain
of headache with repeated vomiting for 6 months with progressive
clinical picture, for what MRI done showing a huge suprasellar mass,
which could be a craniopharyngioma or optic chiasm glioma. It has
major extension to the third ventricle and retrosellar involvement.
The mass was pushing the ACAa anteriorly.
The patient was sent for further examination and
the visual fields were constricted both eyes. visual acuity
right eye 6/9, left 6/24 accordingly. with no swelling of the optic
nerves. No signs of diabetes
insipidus or hormonal disturbances.
Bifrontal monoflap osteoplastic craniotomy was
done with reflection of the bony flap to the right ear. The anterior
lower edge of the bony defect was flush with the base of the
anterior fossa. Mobilization of both olfactory tracts was performed
and the brain was slightly retracted. The optic nerves were of
prefix variant and they were enlarged, as ballooning by a mass.
Inspection of both carotids, revealed, that the enlarged chiasm
occupying the whole suprasellar area. The suprachiasmatic
cistern was opened by sharp dissection and after 25 mm behind the
anterior edge of the chiasm, the optic chiasm glioma start to be
visible, from where FFB was done, which confirmed a high-grade
astrocytoma. The tumor was violet-bluish in color and it was easily
resectable. Subtotal resection of the tumor was done, after what it
was possible to see the floor of the third ventricle and the optic
nerves regained more or less normal appearance. The perichiasmatic
cisterns got relaxed position and the ICAa hanging free.
Uneventful postoperative recovery. No
deterioration of the visual and olfactory functions.
Comments: 1.
This is an example about subfrontal approach with preservation of
the olfactory tracts after their mobilization from the mediobasl
frontal lobes. You can notice that, they are not making obstacle to
the surgical manipulations, even after dissection of the
suprachiasmatic cistern and working in the third ventricle.
2. It is early to tell now, but almost radical resection of the
glioma can be achieved if the boundaries and consistency can make
the surgeon able to do that. This can help in improving the
postoperative results. | 
