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Objective: The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor. Methods: Endoscopic endonasal dissections of the CVJ were completed in 35 cadaveric specimens. The area of exposure (AoE) and caudal-most reach were measured using a navigation system. Radiographic measurements included the distance of the odontoid process from the hard palate, length of the hard palate, distance of the lowest point reached from the hard palate level, and angles such as the nasopalatine line (NPL) angle, nasoaxial line (NAxL) angle, nostril-hard palate line (NTL) angle, and rhinopalatine line (RPL) angle. Results: The mean CVJ AoE was 931.22 ± 79.36 mm2. The NPL, NAxL, and RPL angles showed significant negative correlations with the distance of the odontoid process from the hard palate line (r = -0.521, p = 0.001; r = -0.538, p = 0.001; r = -0.500, p = 0.002, respectively), while the NTL angle did not (r = -0.241, p = 0.162). No significant correlation was found between achieved AoE via EEA and NPL, NAxL, NTL, or RPL (p > 0.05). Importantly, hard palate length was the sole predictor of CVJ AoE variability (r = -0.416, p = 0.013), with shorter lengths associated with increased exposure. The mean distance of the lowest point reached in the AoE from the hard palate level was 9.47 ± 1.24 mm. Conclusions: This anatomic study highlights the variability in CVJ anatomy and the limitations of using previously defined radiographic anthropometric lines for predicting the caudal limits of the EEA. Hard palate length emerged as the only reliable predictor of the surgical area of exposure via the endonasal corridor. Clinical studies are warranted to validate these findings and define the potential need for adjunctive surgical routes in managing complex CVJ pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Craniopharyngiomas (CPs) are benign and rare tumors found in adults. Their location close to vital neurovascular structures makes traditional treatment modalities (surgery and radiation) challenging and potentially fraught with morbidity. The 2021 WHO classification has divided what was previously considered two subtypes of craniopharyngioma into separate entities. Identification of specific molecular driver mutations in each type- BRAF V600E in papillary craniopharyngiomas (PCP) and CTNNB1 in adamantinomatous craniopharyngiomas (ACP) has resulted in a paradigm shift in the management of adult CPs. Methods: In this study, we describe our experience in treating PCPs with targeted therapy and highlight nuances in management accounting for current evidence. This review also explores the current scope and application of precision oncology in adult CPs including the experience with ongoing trials and prospects for future research. Results: The high prevalence of targetable mutation in cases of PCP and the efficacy of BRAF inhibitors alone or in combination with MEK inhibitors has improved the disease control in these patients. In the current scenario, while surgery is warranted to obtain histopathological diagnosis, radical resection and its associated risks can be avoided. In case of ACPs, dysregulation of multiple pathways has been implicated. This has prompted the use of a variety of targeted therapies with inconsistent outcomes. The results of ongoing and future trials may define its role in management. Conclusion: Precision oncology is a promising addition to the treatment armamentarium of adult CPs. [ABSTRACT FROM AUTHOR]

Byline: Atul. Goel, Sagar. Bhambere, Abhidha. Shah, Hardik. Darji, Chandrima. Biswas, Akshay. Hawaldar Background: A number of complications following surgery aimed at atlantoaxial fixation have been reported. However, there is [...]

Background: Epidermoid cyst (EC) located completely within the pituitary infundibulum is a rare entity with only seven reported cases. In this study, we have described our experience with resection of intra-infundibular epidermoid cysts (IECs) and reviewed the existing literature highlighting its distinguishing features and operative nuances., Methods: Three consecutive cases of IEC operated at our institute was retrospectively studied. PubMed and EMBASE databases were searched, and seven case reports of IEC were found. Relevant clinical, radiological, operative data of ten cases were analyzed., Results: The median age at diagnosis was 53.5 years and six cases were males. Preoperatively, although the average tumor size was only 1.62 cm 3 , 80% of patients had visual disturbance, and 78% of patients had deficiency in pituitary hormones. Five patients had preoperative diabetes insipidus. Mild diffusion restriction was noted in four out of five cases that mentioned it. The most common differential diagnosis considered was Rathke's cleft cyst and craniopharyngioma. Adhesion of the cyst wall to the stalk and/or the hypothalamus was a common occurrence resulting in residual wall being left behind in 50% cases. Expanded endoscopic endonasal approach was utilized in nine cases and one case underwent fronto-temporal craniotomy with resection via pretemporal approach. Postoperative chemical meningitis was demonstrated in two cases and sterile abscess was noted in another case., Conclusion: IECs are rare tumors that are often misdiagnosed preoperatively. They have different postoperative morbidity profiles compared to other cystic lesions in the infundibulum. This makes it important to recognize this distinct entity., (Copyright © 2025. Published by Elsevier Inc.)