Complex Pediatric Craniopharyngioma with Suprachiasmatic Extension and Vascular Involvement

A 5-year-old boy presented after undergoing cyst fenestration of an adamantinomatous craniopharyngioma with suprachiasmatic extension causing bitemporal hemianopsia and hypopituitarism. Endoscopic endonasal approach was taken with precise resection of tumor between optic nerve and ACA and meticulous preservation of subcallosal arteries. Gross total resection was obtained with normalization of visual fields postoperatively. This case illustrates technical nuances related to resection of challenging craniopharyngiomas with suprachiasmatic extension and risk of injury to adjacent subcallosal arteries.