Expanded Endonasal Endoscopic Surgery in Suprasellar Craniopharyngiomas: A Retrospective Analysis of 43 Surgeries Including Recurrent Cases

Abstract

BACKGROUND The role of expanded endonasal endoscopic surgery for primary and recurrent craniopharyngioma is not yet fully established. OBJECTIVE To report and evaluate our experience with the endoscopic endonasal approach (EEA) for the resection of primary and recurrent craniopharyngiomas. METHODS This is a retrospective cohort analysis of 43 consecutive EEA procedures in 40 patients operated from September 2006 to February 2012 for suprasellar craniopharyngiomas. In 21 patients (48.8%) the disease was recurrent. We have assessed the surgical results, visual, endocrinological, and functional outcomes and resection rates in this patient cohort. RESULTS At presentation, 31 (72.1%) patients had visual deficits, 15 patients (34.9%) complained of headaches, 25 patients (58.1%) had anterior pituitary insufficiency, and 14 (32.5%) had diabetes insipidus. Total resection was achieved in 44.2% surgeries, of which 77.3% were in primary lesions and 9.5% in recurrent lesions (P < .001). Vision improved in 92.6% patients and worsened in 2.3%. Complications other than vision were encountered in 25.6% including 9/43 cerebrospinal fluid leak, 2/43 meningitis. A total of 51.9% of patients with preoperative residual anterior pituitary function had new anterior pituitary deficiencies and 42.8% had new diabetes insipidus. There was no mortality. Six patients (14%) had recurrence of disease during the follow-up period (mean 56.8 mo), 5 of which required repeat surgery. CONCLUSION The EEA can be integrated in the overall management of both primary and recurrent craniopharyngiomas with good results; however, in our series recurrent surgery was associated with significantly lower rates of gross total resection.

Craniopharyngioma in Adults - Neurosurgical Outcome

“…In our cohort the rate of GTR is not impressive (35%) but it is comparable to other very recently reported surgical series 3 . GTR was associated with signifi cantly more important impairment in the functioning of both anterior and posterior pituitary (hypopituitarism, permanent diabetes insipidus) in our cohort, a fi nding similar to that reported by other researchers 4 .…”

Stereotactic cysto-ventricular catheters in craniopharyngiomas: an effective minimally invasive method to improve visual impairment and achieve long-term cyst volume reduction

“…In our patient group, visual impairment was improved in most patients following cyst reduction via CVC implantation in the immediate postoperative course, with no patients showing deterioration of visual status. Hence, the authors estimate high recovery rates up to 90% following tumour resection strategies and also surgery-related visual deterioration in about 15% of patients [12,35]. Minimally invasive approaches for cyst reduction seem superior in achieving immediate visual improvement given the high rate of recovery and the near absence of new ophthalmological deficits [28,36].…”

“…One of our patients suffered from a new onset of complete pituitary dysfunction 18 months after CVC implantation and adjuvant radiation therapy without new imaging aspects; therefore, this development could not be attributed to surgery. In contrast, tumour resection via the transcranial or transsphenoidal approach carries a high risk for endocrinological worsening with surgery-related new complete or incomplete pituitary dysfunction in over 50% of cases compared to minimally invasive strategies [15,35,37].…”

Prediction of Post-operative Visual Deterioration Using Visual-Evoked Potential Latency in Extended Endoscopic Endonasal Resection of Craniopharyngiomas

“…IONM, as an important method to protect neurological function during surgery, has been widely used in various neurosurgical procedures. At present, EEEA is the optimal surgical approach for craniopharyngioma surgery without significant lateral invasion ( 11 , 12 ). As the tumor is adjacent to the optic nerve and chiasm, the surgical removal of the tumor may lead to strain damage to the optic nerve and chiasm, and thus result in new or intensified deterioration of visual function post-operatively, which can significantly decrease the quality of life of the patients.…”

“…Adhesion forces between neoplasms and optical nerves were classified into two categories according to the intraoperative findings of the surgeon: (1) no or loose adhesion if the tumor can be easily separated from the optic apparatus with gentle blunt dissection using dissectors; or (2) tight adhesion if separation of the tumor needed sharp dissection using scissors ( 11 , 12 ).…”