Abstract: ObjectiveTo investigate the pattern of the relationship of craniopharyngiomas with pituitary stalks and hypothalamus. Furthermore, based on different patterns affirmed during the operations, surgical strategies were designed for radical excision. MethodsA series of 66 patients with primary suprasellar craniopharyngiomas were treated with microsurgical techniques and the relationships of the craniopharyngiomas with pituitary stalk and hypothalamus were analyzed prospectively. Appropriate surgical approaches were selected preoperatively according to the lesion's sizes and expanding directions. The relationships of the lesions to the pituitary stalks and hypothalamus were identified in detail and dissected carefully with protection of perforating vessels. ResultsThe patterns that pituitary stalks were involved by craniopharyngiomas were identified in 36 cases and divided into four types: no relation (5 cases), adhesion (10 cases), partial invasion (8 cases) and total invasion (13 cases). The anterior floor of the third ventricle was involved in 42 cases, in which it disappeared totally in 10 cases. Total resection was achieved in 58 case, subtotal resection in 8 cases. Diabetes insipidus (DI) was identified in 44 cases postoperatively. No surgical mortality, no recurrence was found during follow-up of mean 35 months. ConclusionThe appropriate selection of surgical approaches preoperatively, careful identification and according treatment of the relationships of the tumors with pituitary stalks and hypothalamus are the keys to protect the pituitary stalk; hypothalamus in craniopharyngiomas resection in adults.

Key words: craniopharyngiomas, pituitary stalk, hypothalamus