A case of Dr. Fernando Muñoz
In this case uploaded to the surgical training app SurgSchool, we dive into a complex surgery performed by renowned neurosurgeon Dr. Fernando Muñoz, a skull base expert operating in Barcelona, Spain. The intervention that we will analyze in detail is the Endoscopic suprasellar approach for resection of craniopharyngioma, an advanced technique that allows access to tumors located in deep areas of the brain with precision and less invasiveness compared to traditional surgeries.
Case Context
The patient is a man of 59 years who presented symptoms of cognitive impairment, memory loss e Urinary incontinence over a period of about six weeks. An MRI revealed the presence of a Suprasellar lesion compatible with a craniopharyngioma, a type of benign tumor but difficult to treat due to its proximity to critical structures such as the optic chiasma and hypothalamus.
Surgical Plan: Expanded Endoscopic Approach
Dr. Muñoz and his team decided to opt for a expanded suprasellar endoscopic approach, which allows direct access to the tumor region with less invasion of the surrounding tissues. This technique has the advantage of reducing the risk of postoperative complications and shortening recovery time.
One of the critical phases of this surgery is the bone exposure, where adequate visualization of both is ensured medial optic-carotid recesses. Once opened the dura mater and slightly released the hypophysis, the tumor is accessed. The patient, in this case, only presented a hormonal deficiency related to the secretion of sexual hormones.
Tumor Resection Procedure
During the surgery, the team led by Dr. Muñoz proceeded with a progressive debulking of craniopharyngioma, trying to preserve the hypophyseal stalk and minimize the risk of damaging critical structures. The objective was Dissect carefully before performing any traction on the tumor, since it extended to very deep and close areas to the hypothalamus.
In the resection phase, a meticulous technique was used to avoid injuring perforating arteries and ensure that each movement was precise, avoiding "blind" actions that could compromise the patient's integrity. arteries that depend on the posterior circulation They were dissected with extreme care to avoid uncontrolled bleeding.
Reconstruction and Hemostasis
Once the tumor resection was completed, the team proceeded with the hemostasis and reconstruction of the skull base. Multiple layers of tissue were placed, starting with a fascia inlay and followed by fascia lata or with a nasoseptal flap to ensure a tight seal. In addition, a external lumbar drainage which was maintained for four days to reduce postoperative intracranial pressure.
Postoperative Results and Follow-up
El Postoperative CT scan showed an apparently complete resection without obvious complications. However, the resonance revealed a small lesion in the midbrain, which did not cause any major clinical problems. Despite the successful removal of the tumor, the patient continues to present a residual neurological impairment, which requires a intensive rehabilitation program to try to recover their cognitive functions.
