Technique and outcome of endoscopy-assisted microscopic extended transsphenoidal surgery for suprasellar craniopharyngiomas

Abstract

The transcranial approach has been the standard technique for removal of craniopharyngiomas for several decades. However, many reports of successful suprasellar craniopharyngioma removal accomplished using extended transsphenoidal surgery (TSS) have recently been published. In the present study, the authors describe their technique and the outcomes of removal of suprasellar craniopharyngiomas aided by the use of an operating microscope and an endoscope concurrently during extended TSS. Between 1999 and 2008, 18 patients with suprasellar craniopharyngiomas underwent TSS. Tumors that adhered to the optic nerve were safely dissected, and fine perforating vessels were precisely preserved with the aid of a magnified, detailed microscopic view. Portions of the tumor that could not be properly visualized with the microscope were visualized with the endoscope. Total resection was achieved in all patients, and all visual symptoms improved. Preoperative hypopituitarism improved in 2 patients but persisted postoperatively in 15 patients (hormonal outcome was not available in 1 patient). Diabetes insipidus was present in 16 patients postoperatively. Cerebrospinal fluid leakage developed in 3 patients in the conventional fascia lata graft group, whereas no CSF leakage occurred after the dural suture technique with a fascia lata graft was introduced. This technique could be more precisely applied when using a microscopic view. Tumor recurrence was documented for 1 patient 2 years after surgery. The authors achieved good results by using extended TSS for the removal of suprasellar craniopharyngiomas. Endoscopy-assisted microscopic extended TSS harnesses the advantages of a microscope as well as those of an endoscope. Surgeons should consider using the advantages of both surgical modalities to achieve the best result possible.