{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:57:09Z","timestamp":1770627429763,"version":"3.49.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Preservation of the pituitary stalk and its vasculature is a key step in good postoperative endocrinological outcome in patients with craniopharyngiomas. In this article, the authors describe the surgical technique of medial optic nerve mobilization for better inspection and preservation of the pituitary stalk.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This operative technique has been applied in 3 patients. Following tumor exposure via a frontolateral approach, the pituitary stalk could be seen partially hidden under the optic nerve and the optic chiasm. The subchiasmatic and opticocarotid spaces were narrow, and tumor dissection from the pituitary stalk under direct vision was not possible. The optic canal was therefore unroofed, the falciform ligament was incised, and the lateral part of the tuberculum sellae was drilled medial to the optic nerve. The optic nerve could be mobilized medially to widen the opticocarotid triangle, which enhanced visualization of and access to the pituitary stalk.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>By using the optic nerve mobilization technique, the tumor could be removed completely, and the pituitary stalk and its vasculature were preserved in all patients. In 2 patients, vision improved after surgery, while in 1 patient it remained normal, as it was before surgery. The hormonal status remained normal after surgery in 2 patients. In the patient with preoperative hormonal deficiencies, improvement occurred early after surgery and hormonal levels were normal after 3 months. No approach-related complications occurred.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This early experience shows that this technique is safe and could be used as a complementary step during microsurgery of craniopharyngiomas. It allows for tumor dissection from the pituitary stalk under direct vision. The pituitary stalk can thus be preserved without jeopardizing the optic nerve.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.6.jns141847","type":"journal-article","created":{"date-parts":[[2015,12,18]],"date-time":"2015-12-18T15:43:20Z","timestamp":1450453400000},"page":"683-688","source":"Crossref","is-referenced-by-count":5,"title":["Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience"],"prefix":"10.3171","volume":"125","author":[{"given":"Hussam","family":"Metwali","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venelin","family":"Gerganov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolf","family":"Fahlbusch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2 Suppl","key":"b1-jns141847","series-title":"J Neurosurg","first-page":"87","article-title":"The petrosal approach for the total removal of giant retrochiasmatic craniopharyngiomas in children","volume":"106","author":"Al-Mefty","year":"2007"},{"issue":"6A","key":"b2-jns141847","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Subfrontal transbasal approach and technique for resection of craniopharyngioma","volume":"18","author":"Aryan","year":"2005"},{"key":"b3-jns141847","series-title":"Clinical article J Neurosurg","first-page":"1078","article-title":"Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients","volume":"111","author":"Bassiouni","year":"2009"},{"key":"b4-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/BF01400850","article-title":"Status of vision following surgical treatment of craniopharyngiomas","volume":"73","author":"Cabezudo Artero","year":"1984"},{"key":"b5-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"100","DOI":"10.3171\/2014.3.JNS131521","article-title":"The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients","volume":"121","author":"Cavallo","year":"2014"},{"issue":"3 Suppl","key":"b6-jns141847","series-title":"Neurosurgery","first-page":"ons96","article-title":"The \u201cno-drill\u201d technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region","volume":"64","author":"Chang","year":"2009"},{"key":"b7-jns141847","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"692","DOI":"10.3109\/02688697.2012.673648","article-title":"Endoscopic endonasal extended transsphenoidal removal of tuberculum sellae meningioma (TSM): an experience of six cases","volume":"26","author":"Chowdhury","year":"2012"},{"key":"b8-jns141847","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3171\/2009.7.PEDS09215","article-title":"Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children","volume":"5","author":"Elliott","year":"2010"},{"key":"b9-jns141847","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3171\/2010.8.PEDS09385","article-title":"Surgical management of giant pediatric craniopharyngiomas","volume":"6","author":"Elliott","year":"2010"},{"key":"b10-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1007\/s00701-008-0137-9","article-title":"Surgical management of giant craniopharyngiomas","volume":"150","author":"Fahlbusch","year":"2008"},{"key":"b11-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"237","DOI":"10.3171\/jns.1999.90.2.0237","article-title":"Surgical treatment of craniopharyngiomas: experience with 168 patients","volume":"90","author":"Fahlbusch","year":"1999"},{"key":"b12-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3171\/2013.9.JNS122133","article-title":"Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome","volume":"120","author":"Gerganov","year":"2014"},{"key":"b13-jns141847","series-title":"Acta Neurochir Suppl (Wien)","first-page":"349","article-title":"Craniopharyngiomas. Results of surgical treatment","volume":"28","author":"Guidetti","year":"1979"},{"key":"b14-jns141847","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/0090-3019(85)90300-3","article-title":"Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas","volume":"24","author":"Hakuba","year":"1985"},{"key":"b15-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"47","DOI":"10.3171\/jns.1992.76.1.0047","article-title":"Aggressive surgical management of craniopharyngiomas in children","volume":"76","author":"Hoffman","year":"1992"},{"key":"b16-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"373","DOI":"10.3171\/2011.6.JNS081451","article-title":"Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997","volume":"116","author":"Hofmann","year":"2012"},{"key":"b17-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1007\/s00701-011-0973-x","article-title":"Benefit of 1.5-T intraoperative MR imaging in the surgical treatment of craniopharyngiomas","volume":"153","author":"Hofmann","year":"2011"},{"key":"b18-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"251","DOI":"10.3171\/jns.1999.90.2.0251","article-title":"Surgical treatment of craniopharyngiomas: endocrinological results","volume":"90","author":"Honegger","year":"1999"},{"key":"b19-jns141847","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/0090-3019(93)90104-9","article-title":"The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma","volume":"39","author":"Honegger","year":"1993"},{"key":"b20-jns141847","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1227\/NEU.0b013e318262146b","article-title":"Longitudinal analysis of visual outcomes after surgical treatment of adult craniopharyngiomas","volume":"71","author":"Kim","year":"2012"},{"key":"b21-jns141847","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.wneu.2011.07.011","article-title":"Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas","volume":"77","author":"Komotar","year":"2012"},{"key":"b22-jns141847","series-title":"Arq Neuropsiquiatr","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1590\/S0004-282X2010000300019","article-title":"Tuberculum sellae meningiomas: surgical considerations","volume":"68","author":"Landeiro","year":"2010"},{"key":"b23-jns141847","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1227\/NEU.0b013e31822e8ffc","article-title":"Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index","volume":"70","author":"Leng","year":"2012"},{"key":"b24-jns141847","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1227\/00006123-199504000-00012","article-title":"Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches","volume":"36","author":"Maira","year":"1995"},{"key":"b25-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s00701-012-1485-z","article-title":"Surgical unroofing of the optic canal and visual outcome in basal meningiomas","volume":"155","author":"Mariniello","year":"2013"},{"key":"b26-jns141847","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.wneu.2013.02.032","article-title":"The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned","volume":"82","author":"Mascarenhas","year":"2014"},{"key":"b27-jns141847","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1227\/01.NEU.0000228683.79123.F9","article-title":"Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression","volume":"59","author":"Mathiesen","year":"2006"},{"key":"b28-jns141847","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.clineuro.2011.12.021","article-title":"Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas","volume":"114","author":"Mortini","year":"2012"},{"key":"b29-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1007\/s00701-013-1685-1","article-title":"How I do it: anterior clinoidectomy and optic canal unroofing for microneurosurgical management of ophthalmic segment aneurysms","volume":"155","author":"Sai Kiran","year":"2013"},{"key":"b30-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"2103","DOI":"10.1007\/s00701-011-1171-6","article-title":"Exclusively intradural exposure and clip reconstruction in complex paraclinoid aneurysms","volume":"153","author":"Seifert","year":"2011"},{"key":"b31-jns141847","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1007\/s00701-013-1704-2","article-title":"Safety of drilling for clinoidectomy and optic canal unroofing in anterior skull base surgery","volume":"155","author":"Spektor","year":"2013"},{"key":"b32-jns141847","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1007\/s00381-005-1203-8","article-title":"Origin of craniopharyngiomas: implication on the growth pattern","volume":"21","author":"Wang","year":"2005"},{"key":"b33-jns141847","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/jns.1990.73.1.0003","article-title":"Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients","volume":"73","author":"Ya\u015fargil","year":"1990"},{"key":"b34-jns141847","series-title":"Chin Med J (Engl)","first-page":"357","article-title":"Changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas","volume":"117","author":"Zhou","year":"2004"},{"key":"b35-jns141847","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s00381-005-1201-x","article-title":"Radical resection of craniopharyngioma","volume":"21","author":"Zuccaro","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/125\/3\/article-p683.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/125\/3\/article-p683.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/125\/3\/article-p683.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T23:51:51Z","timestamp":1682812311000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/125\/3\/article-p683.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":35,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2015.6.jns141847","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9]]}}}