Abstract
Results of primary transnasal surgery were evaluated in 35 patients (18 males and 17 females) with intrasellar and suprasellar craniopharyngiomas treated between 1985 and 1996 when more refined surgical and diagnostic techniques were available. Patients ranged in age from 8 to 72 years (mean 27 years); 14 patients were younger than 18 years of age. The transnasal approach was chosen because of sellar enlargement and presence of infradiaphragmatic tumor. The paramedian portion of the normal pituitary gland was incised vertically to reach a dorsally located tumor in 25 patients. Complete tumor resection was achieved in 15 patients and subtotal removal in 19; in one patient, only aspiration of cyst contents was performed. Tumor regrowth was seen in three patients after subtotal removal; in two, total tumor removal was achieved by a second transnasal surgery, whereas radiotherapy was administered in the other. In a single patient, total tumor removal was achieved by a second transcranial surgery after cyst aspiration. The duration of the clinical follow-up period was at least 1 year. Persistent diabetes insipidus appeared after total tumor resection in five patients. Cerebrospinal fluid leakage occurred in three patients, with two requiring revision. Among 29 patients with preoperatively normal pituitary functions, 20 (69%) were preserved after primary total resection, whereas six (19.4%) of 31 previously disturbed functions were normalized. After subtotal removal including cyst aspiration, 39 (88.6%) of 44 normal functions were preserved, whereas nine (24.3%) of 37 disturbed functions were normalized. The transnasal approach should be the first choice in infradiaphragmatic craniopharyngiomas with sellar enlargement in cases in which the extrasellar portion is mostly cystic and is accessible. The concept of subtotal removal with preservation of pituitary functions, especially when treating craniopharyngioma in children, seems to be justified.
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