Endonasal Endoscopic Surgery for Recurrent Craniopharyngiomas Can Be Equally Effective as Initial Surgery and Ought to Be Offered before Contemplating Radiation

Abstract

Background: Recurrent craniopharyngiomas have been offered radiation due to presumed higher rates of complications with surgery. The distinct importance of endonasal endoscopic surgery on recurrent craniopharyngiomas is not clear. Methods: From prospective database of endonasal endoscopic resection of craniopharyngiomas at WCMC/NYP, 22 recurrent cases were studied in comparison to 35 initial tumors. Prior radiation, visual, endocrine function, body mass index (BMI), quality of life (QOL), tumor volume, extent of resection and complications were compared between groups. Univariate and multivariate statistical analyses were performed. Results: Baseline hypopituitarism (82 vs. 60%) and DI (55 vs. 9%) were significantly more frequent with recurrent tumors (p < 0.001). Rates of gross total resection (GTR) were not significantly different between the two groups (90 vs. 97%). Larger and radiated tumors had lower GTR. Higher trend of postoperative pituitary dysfunction was noted in recurrent group (51 vs. 23% new anterior pituitary dysfunction, 80 vs. 47% new diabetes insipidus, p = 0.08). Vision improved equally in both groups (80 vs. 73%). There was no significant difference between the groups with respect to improvement in QOL at 1 year (7.5 vs. 14.5, p = 0.15) and increase in median BMI at 5 years (4.6 vs. 4.4 kg/m2, p = 0.69). Rates of further tumor regrowth were also similar (14 vs. 9%, p = 0.67). Conclusion: Endonasal endoscopic surgery for recurrent craniopharyngiomas results in comparable GTR, visual, QOL and BMI outcome as initial surgery, with no significant increase in complications. Only tumor volume and radiation impacted resection rates. Recurrent craniopharyngiomas ought to be offered endonasal surgery before contemplating radiation.