The patient a boy 9 years age started to
complain of headache with repeated vomiting for
6 months with progressive clinical picture, for
what MRI done showing a huge suprasellar mass,
which could be a craniopharyngioma or optic
chiasm glioma. It has major extension to the
third ventricle and retrosellar involvement. The
mass was pushing the ACAa anteriorly.
Bifrontal monoflap osteoplastic craniotomy was
done with reflection of the bony flap to the
right ear. The anterior lower edge of the bony
defect was flush with the base of the anterior
fossa. Mobilization of both olfactory tracts was
performed and the brain was slightly retracted.
The optic nerves were of prefix variant and they
were enlarged, as ballooning by a mass.
Inspection of both carotids, revealed, that the
enlarged chiasm occupying the whole suprasellar
area. The suprachiasmatic cistern was opened by
sharp dissection and after 25 mm behind the
anterior edge of the chiasm, the optic chiasm
glioma start to be visible, from where FFB was
done, which confirmed a high-grade astrocytoma.
The tumor was violet-bluish in color and it was
easily resectable. Subtotal resection of the
tumor was done, after what it was possible to
see the floor of the third ventricle and the
optic nerves regained more or less normal
appearance. The perichiasmatic cisterns got
relaxed position and the ICAa hanging free.