Extended endoscopic endonasal approach for recurrent or residual craniopharyngiomas

Abstract

Objective To present our experience in surgical treatment of recurrent or residual craniopharyngiomas through extended endoscopic endonasal approach. Methods A retrospective review of clinical data of 12 patients who were treated for recurrent or residual craniopharyngiomas through extended endoscopic endonasal approach by the Deparment of Neurosurgery, the First Affiliated Hospital of Nanchang University from April 2012 to May 2016. All patients were analyzed in terms of the treatment effect, complications, and follow-up results. Results Total removal of the tumors were achieved in 9 cases and subtotal removal in 3 cases. The pituitary stalks were identified in 8 cases during operations and secured in 7 cases. Postoperative visual acuity was improved in 8 cases and remained at the preoperative level in the other 4 cases. There was no significant difference between pre- and postoperative endocrine function, except for 1 patient with normal preoperative endocrine function who developed panhypopituitarism post surgery. Postoperative diabetes insipidus occurred in 11 patients including 1 patient who had long-term diabetes insipidus and others reporting transient postoperative diabetes insipidus. No cerebrospinal fluid (CSF) leak was identified. Intracranial infection was observed in 1 case and resolved with enhancement of anti-infection medication and extension of CSF drainage time. One case was lost to follow-up. There were no deaths or recurrence reported during the follow-up (3-45 months). Obesity developed in 2 patients. The cases with preoperative hypopituitarism were not improved. Conclusions Considering the adhesion of recurrent or residual craniopharyngiomas to their surrounding structures, extended endoscopic endonasal approach could be safe and effective with minimally invasiveness owing to its advantages including wide-angle view, close observation, and less traction and dissection of brain tissues. Key words: Craniopharyngioma; Neoplasm recurrence, local; Neuroendoscopy; Treatment outcome