Endoscopic cyst fenestration followed by mini-orbitozygomatic craniotomy via eyebrow incision: a novel approach for resection of cystic craniopharyngioma. Patient series.

BACKGROUND: Craniopharyngioma is a rare, noncancerous tumor that develops from Rathke's pouch. Gross-total resection (GTR) is essential to reduce the risk of recurrence. Once the cyst is decompressed, it can be difficult to appreciate how the cyst wall collapses intraoperatively and achieve a GTR. In this case series, the authors suggest endoscopic cyst fenestration (ECF) with outpatient imaging, followed by mini-orbitozygomatic craniotomy via eyebrow incision (EOZ) for resection of cystic craniopharyngioma. OBSERVATIONS: There were 5 patients included in this single-institution retrospective study. Of those patients, 4 received a GTR. The patient with a subtotal resection underwent craniotomy with an anterior interhemispheric approach to remove the remaining tumor. Four patients had preoperative hormone dysfunction; all patients required hormone replacement postoperatively. There were no surgical complications. No patients demonstrated recurrence on imaging at their most recent follow-up. LESSONS: ECF followed with postoperative imaging can help determine how the cyst wall involutes. ECF followed by EOZ can provide more clarity on the geometry of the cyst wall and maximize the likelihood of GTR. This approach should be considered in patients with existing hormone dysfunction with the goal of GTR. https://thejns.org/doi/10.3171/CASE2624.