Clinical analysis of extended endoscopic endonasal approach for craniopharyngioma treatment

Abstract

Objective To evaluate the efficacy and safety of extended endoscopic endonasal approach for resection of craniopharyngiomas. Methods The clinical data of 32 patients with craniopharyngiomas undergoing extended endoscopic endonasal surgery at Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University between November 2014 and May 2016 were analyzed retrospectively. The visual improvement, extent of resection and surgical complications were evaluated. Results The gross total resection (GTR) rate was 69% (22/32), near-total resection (> 95% of tumor removed) was 25% (8/32), and subtotal resection (≥ 80% of tumor removed) was 6% (2/32). Overall, 28 patients presented with visual impairment. In 86% (24 patients) of them, visions were improved or even recovered to normal following surgery. Worsening of the anterior pituitary function was reported in 53% (17 patients) of all, and there were 12 new cases (48% of 25) of postoperative diabetes insipidus. Thirteen (41%) patients had hyposmia and 3 (9%) patients developed severe hypomnesia after surgery. CSF leakage and secondary meningitis occurred in 1 (3%) patient postoperatively. One (3%) patient had brainstem hemorrhage after surgery. The follow-up lasted 4-22 months. No tumor recurrence was identified by MRI examination, and one patient died. Conclusions The extended endoscopic endonasal approach for craniopharyngiomas seems generally effective and safe with high GTR rate, which however could also cause damage of hypothalamic-pituitary axis. Thus, continuous attention should be paid to preservation of the endocrine function during surgical management of craniopharyngioma. Key words: Craniopharyngioma; Neuroendoscopy; Neurosurgical procedures; Treatment outcome; Extended endonasal approach