The surgical treatment of the extended endoscopic endonasal approach (EEEA) is a safe and effective treatment for suprasellar craniopharyngiomas. However, due to damage to the hypothalamus and third ventricle floor (TVF), EEEA is generally regarded as unsuitable in treating intrinsic third ventricle craniopharyngioma (ITVC) that is entirely within the third ventricle. Until now, there have been only a small number of reports using EEEA to treat TVC via a supra-infrachiasmatic approach. Given that the translamina terminalis (TLT) corridor was used in the transcranial subfrontal approach, EEEA via a suprachiasmatic approach may be feasible and practical to treat ITVC. In the current study, we accumulated experience applying the suprachiasmatic translamina terminalis (STLT) corridor for anterior treatment of ITVC.

From March 2016 to December 2020, 14 patients with ITVC in our center were analyzed retrospectively. All patients underwent surgery by EEEA via an STLT corridor. The multilayer reconstruction technique was adopted to achieve skull base reconstruction. Data concerning the patient’s tumor resection, vision, hypophyseal hormone, and complications were collected.

Gross-total resection was achieved in 13 (92.8%) of14 patients, with achievement of near-total (90%) resection in the remaining 1 patient. Nine cases (64.3%) were papillary craniopharyngiomas, and the other 5 cases were adamantinomatous subtypes. Postoperatively, 3 patients with pituitary insufficiency received hormone replacement therapy. No permanent diabetes insipidus or hypothalamic obesity was found. All pairs showed significant improvement or stability in vision except 1 patient who encountered visual deterioration. No other neurological deficit occurred postoperatively. Observation results for the exudation of nasal tissue and the length of hospitalization were satisfactory. After a mean follow-up period of 26.2 months, tumor recurrence was not observed.

TLT is a minimally invasive corridor used in EEEA for treating anterior ITVC without increasing risks of visual and hormonal deficits. The multilayered reconstruction technique we used is a safe and effective method for achieving watertight closure and avoiding cerebrospinal fluid leaks and infection. The endonasal approach via STLT provides a new, safe and efficacious operative strategy that should be considered a surgical alternative in treating ITVC.

扩大内镜下鼻内入路（EEEA）的手术治疗是治疗鞍上颅咽管瘤安全有效的方法。然而，由于对下丘脑和第三脑室底（TVF）的损伤，EEEA通常被认为不适合治疗完全位于第三脑室内的内源性第三脑室颅咽管瘤（ITVC）。到目前为止，只有少数报道使用EEEA治疗TVC通过一种超视交叉上的方法。鉴于在经颅额下入路中使用了终板 (TLT) 通道，EEEA通过视交叉上的方法治疗 ITVC 可能是可行和实用的。在目前的研究中，我们积累了应用视交叉上椎板 (STLT) 通道进行 ITVC 前路治疗的经验。

对2016年3月至2020年12月我中心14例ITVC患者进行回顾性分析。所有患者均接受EEEA手术通过STLT 走廊。采用多层重建技术实现颅底重建。收集有关患者肿瘤切除、视力、垂体激素和并发症的数据。

14 例患者中有 13 例（92.8%）实现了大体全切除，其余 1 例实现了近全切除（90%）。9例（64.3%）为乳头状颅咽管瘤，5例为金刚瘤亚型。术后3例垂体功能不全患者接受了激素替代治疗。未发现永久性尿崩症或下丘脑肥胖。除了 1 名出现视力恶化的患者外，所有对都显示出视力的显着改善或稳定性。术后无其他神经功能缺损发生。鼻组织渗出及住院时间观察结果满意。平均随访 26.2 个月后，未观察到肿瘤复发。

TLT 是 EEEA 中用于治疗前部 ITVC 的微创通道，不会增加视力和激素缺乏的风险。我们使用的多层重建技术是实现水密闭合和避免脑脊液泄漏和感染的一种安全有效的方法。经鼻入路通过STLT 提供了一种新的、安全和有效的手术策略，应被视为治疗 ITVC 的手术替代方案。