{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:14:09Z","timestamp":1769300049646,"version":"3.49.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The endoscopic endonasal approach has been proposed as a primary surgical strategy for select craniopharyngiomas. However, those tumors that arise from the sella have not been classified with the other craniopharyngioma subtypes in terms of surgical nuances, intraoperative findings, and postoperative outcomes. The authors describe their experience with a select subtype of craniopharyngioma arising within the sella subjacent to the diaphragma sellae and refer to these tumors as type 0.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>After obtaining IRB approval, three institutions retrospectively reviewed their data collected from 2005 to 2017. Patients eligible for inclusion in the study were those who had tumors that originated from the sella inferior to the diaphragma sellae. Demographic, clinical, radiological, surgical, and follow-up data were examined and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty-eight patients (average age 19.3 years, range 3\u201360 years) were included in this study. Sixteen patients (57%) were younger than 18 years of age. All patients had characteristic imaging features of an expanded sella. Seventy-five percent of the patients presented with some form of visual field deficit (89% had radiographic optic apparatus compression) and 39% with hypopituitarism. The average maximal tumor diameter in the axial, coronal, or sagittal plane was 3.1 cm. Gross-total resection was achieved in 82% of the patients. Twenty-one percent of patients experienced an iatrogenic complication, and there were only two cases (7%) of postoperative cerebrospinal fluid (CSF) leakage. Only two patients (7%) required the use of a nasoseptal flap as part of their original reconstruction. Pathology was uniformly the adamantinomatous subtype. Postoperative objective visual outcomes were improved in 71% of the patients with visual symptoms or visual field deficits on presentation and stable in 24%. Mean follow-up was 45.1 months (range 3\u2013120 months) with an 18% recurrence rate at a mean of 44.4 months (range 10\u201384 months). One patient was lost to follow-up. Thirty-six percent of patients received postoperative radiation to treat recurrence or residual tumor. Endocrine data are also presented.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Craniopharyngiomas that originate within the sella below the diaphragma sellae are a select subtype characterized by 1) an enlarged sella, 2) an intact diaphragma sellae at surgery, and 3) an adamantinomatous pathology. These tumors can be treated transnasally without the absolute need for neurovascular flap reconstruction, as there is a low risk of CSF leakage.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.4.jns172330","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T22:53:00Z","timestamp":1542322380000},"page":"526-531","source":"Crossref","is-referenced-by-count":15,"title":["A modern series of subdiaphragmatic craniopharyngiomas"],"prefix":"10.3171","volume":"131","author":[{"given":"Ali O.","family":"Jamshidi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Beer-Furlan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"Sahyouni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of California, Irvine, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Elzoghby","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"},{"name":"Neurosurgery Department, Ain Shams University, Cairo, Egypt; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina G.","family":"Safain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology\u2013Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Jane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3171\/jns.1990.73.1.0012","article-title":"Correlation of clinical and pathological features in surgically treated craniopharyngiomas","volume":"73","author":"Adamson TE","year":"1990","unstructured":"Adamson TE, Wiestler OD, Kleihues P, Ya\u015fargil MG: Correlation of clinical and pathological features in surgically treated craniopharyngiomas. 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