Choice strategies of surgical approaches for craniopharyngiomas

Abstract

Objective To discuss the choice strategies of surgeries approaches for the resection of craniopharyngiomas. Methods The clinical data of 128 patients were retrospectively reviewed who presented with craniopharyngiomas and underwent operations at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University, between August 2007 and March 2017. Craniopharyngiomas were classified into 4 types based on tumor locations: intrasellar type, intra-suprasellar type, suprasellar type and intra-third-ventricle type. The surgical approaches included EEA (endoscopic endonasal approach), lateral subfrontal approach, pterional approach and transcallosal interforniceal approach. With regard to the approaches used for the tumors, 28 were resected via lateral subfrontal approach, 19 via pterional approach, 8 via transcallosal interforniceal approach and 73 via EEA. Results For all 128 cases, gross total resection (GTR) was achieved in 91 (71.1%), near-total resection (NTR) in 35 (27.3%) and partial resection (PR) in 2 (1.6%). For the intrasellar type of tumors, GTR was achieved in 19. For the intra-suprasellar type of tumors, GTR was achieved in 33 and NTR in 15. For the suprasellar type of tumors, GTR was achieved in 28, NTR in 19 and PR in 1. For the intra-third-ventricle type of tumors, GTR was achieved in 11, NTR in 1 and PR in 1. The complication rate of moderate or severe diabetes insipidus (DI), panhypopituitarism and electrolyte disturbances was 40.4% (19/47) for lateral subfrontal approach and pterional approach, 11.0% (8/73) for EEA and 25.0% (2/8) for transcallosal interforniceal approach, whose differences were statistically significant(P=0.001). No surgery-related deaths occurred among the 128 patients. Oculomotor nerve palsy was confirmed in 1 patient who underwent operation through the pterional approach. Postoperative hemorrhage occurred in 1 patient undergoing tumor resection through lateral subfrontal approach and hematoma removal. Leakage of cerebrospinal fluid (CSF) occurred in 4 patients who underwent the EEA approach and repair of the leak. During the follow-up period, tumor recurrence or regrowth occurred in 15 (11.7%) of the 128 cases. Tumor recurrence or regrowth was found in 2 of 19 (10.5%) intrasellar type tumors, 5 of 48 (10.4%) intra-suprasellar type tumors, 7 of 48 (14.6%) suprasellar type tumors and 1 of 13 (7.7%) intra-third-ventricle type tumors. Conclusions The tumor location seems to be the primary key point for choice of surgical approach of craniopharyngiomas. Evaluation of associated damage to hypothalamus is the second key point in approach choice. Key words: Craniopharyngioma; Surgery approach; Neuroendoscopy; Microsurgery