The bifrontal olfactory nerve-sparing approach to lesions of the suprasellar region in children

Suprasellar masses in children include lesions such as craniopharyngiomas a nd germ cell neoplasms, The difficult location of these lesions and their p roximity to important neural and vascular structures pose challenges to res ection. We operated on 14 patients using a bifrontal craniotomy with remova l of both orbital rims to provide access to suprasellar masses, even those with significant extension into the third ventricle, A complete resection w as possible in 8/14 patients and 8/10 craniopharyngiomas, In 13 patients, t he optic nerves were identified and preserved, and vision was stable or imp roved postoperatively, Postoperatively, 1 patient with hydrocephalus develo ped a CSF leak which was successfully treated with a ventriculoperitoneal s hunt. No patient had a cosmetic defect related to orbital rim removal. The bifrontal approach used here enhanced the exposure of the suprasellar regio n and minimized manipulation of the optic apparatus and the carotid arterie s, It may be used alone, or in conjunction with other approaches, to resect lesions in the suprasellar region.