Combined Transcranial Transsylvian and Endoscopic Endonasal Approach for a Giant Craniopharyngioma

A 53-year-old woman presented with bitemporal hemianopsia, cognitive decline, and low cortisol. Imaging showed a giant craniopharyngioma with extension into the left medial temporal lobe, anterior extension above the planum sphenoidale, and extensive invasion into the third ventricle. Given the complexity of the tumor, we performed a single-stage combined pterional transsylvian and endoscopic endonasal approaches with pituitary sacrifice. This strategy allowed near-total removal with dramatic clinical improvement and no complications other than panhypopituitarism.