Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

Abstract

Background Recently the endoscopic endonasal surgery (EES) has been introduced as a modality for the treatment of patients with craniopharyngiomas. In this study, we describe our initial experience in treatment of 29 patients with craniopharyngiomas using this approach. Methods Twenty-nine consecutive patients with craniopharyngiomas who had undergone EES in a 5-year period were studied retrospectively. Patients underwent preoperative and postoperative endocrinologic and ophthalmologic evaluations. Radiologic characteristics of tumors and extent of resection were determined. The recurrence and complications were evaluated. Results Pituitary and visual dysfunction were observed preoperatively in 89.7 and 86% of patients, respectively. After EES, visual outcome either showed an improvement or else remained unchanged in 92.3% of the cases; however, pituitary function remained unchanged and even got worsened in 34.6% of the cases. Prevalence of diabetes insipidus before and after surgery was 58.6 and 69.2%. The rate of gross total resection was 62%. Moreover, 86.2% of the tumors were almost totally resected (more than 95% of the tumor size resected). After surgery, cerebrospinal fluid (CSF) leak and meningitis occurred in four (13.8%) and two (6.9%) patients, respectively. Perioperative mortality was seen in two of the cases (6.9%). The mean follow-up was 25 months and tumor recurrence was discovered in four patients (15.3%). Conclusion The EES with the goal of maximal and safe tumor resection could be used for the treatment of most craniopharyngiomas. Although the rates of visual improvement and gross tumor resection are high, CSF leak, pituitary dysfunction, and meningitis are serious concerns.

Complications in Endoscopic Endonasal Pituitary Adenoma Surgery: An Institution Experience in 310 Patients

“…The rate of ophtalmopathy in previous studies is reported up to 0.68% [15]. In this study 2.6% of the patients experienced post-operative worsening of the visual parameters (visual acuity or field) which were higher than our series in craniopharyngioma patients [26]. One of our patients encountered left side blindness probably due to extensive drilling of the optic canal during surgery.…”

“…15 In this study 2.6% of the patients experienced postoperative worsening of the visual parameters (visual acuity or field) which were higher than our series in craniopharyngioma patients. 26 One of our patients encountered left side blindness probably due to extensive drilling of the optic canal during surgery. Accurate explorations and continuous saline irrigation during drilling may reduce such injuries to optic nerves.…”

Ultrasound-guided endoscopic endonasal resection of sellar and suprasellar craniopharyngiomas

“…Due to the development, evolution and increasing use of endoscopic techniques in the past decades, the Endoscopic endonasal surgery (EES) seems to be replacing the classic transcranial approaches (2,12). The EES allows a better visualization of the tumor and its surrounding structures, consequently a higher percentage of gross total resection have been achieved, associated with reduced morbidity and mortality rates (17)(18)(19).…”

“…Craniopharyngioma (CP) is a benign tumor (classified as grade 1 by the World Health Organization) that originates from the coatings of the Rathke's pouch in the sellar-parasellar region (1,2). Despite the non-malignant histology patterns, the tumor's proximity, and sometimes invasiveness, to adjacent neuro and vascular structures may turn the surgery challenging (1)(2)(3).…”

Minimally invasive procedures for hypothalamic hamartoma–related epilepsy: a systematic review and meta-analysis

“…Because of the deep anatomical location, surgical management of any lesion in this region could be complicated and catastrophic. 9 Resection of HHs has been associated with high rates of mortality and morbidity, but since gross-total resection is not the primary goal (based on their noncancerous histology), minimally invasive ablation methods could be the best treatment option for HH. 2,10 Considering the rarity of HH, the main limitation that narrows available data for comparing alternative treatment modalities, a meta-analysis of available and commonly used treatments could provide comprehensive and more objective insight of the issue.…”