Management of a giant pediatric craniopharyngioma: staged endoscopic endonasal and cranial approaches

Abstract

This report presents a complex case of an 8-year-old female with a giant 8-cm adamantinomatous craniopharyngioma. She had a mixed solid/cystic, multicompartmental tumor with brainstem compression, vascular encasement, obstructive hydrocephalus, and acute stroke on presentation. After neurological improvement with an external ventricular drain, she underwent an extended endonasal approach followed by a left supraorbital craniotomy to address the residual lateral tumor. We achieved a near gross-total resection with improvement in visual acuity, neurocognitive function, and hemiparesis. This case demonstrates that staged skull base approaches can lead to clinically significant and safe resections in the pediatric population. The video can be found here: https://stream.cadmore.media/r10.3171/2026.7.FOCVID26136