Quality-of-Life Preservation after Endoscopic Endonasal Extended Transsphenoidal Resection of Craniopharyngiomas

Objective: Craniopharyngioma is a benign intracranial neoplasm that can be managed with several different treatment modalities such as craniotomy, endonasal endoscopic surgery, and radiation therapy. Maintaining quality of life (QOL) is becoming increasingly important because survival is generally long regardless of treatment. The purpose of this study was to assess the short-term and long-term impact of endoscopic resection on site-specific and sinonasal-related QOL using two validated instruments, the Anterior Skull Base Questionnaire (ASBQ) and the Sinonasal Outcome Test (SNOT-22).

Methods: The ASBQ and SNOT-22 were administered pre- and postoperatively in a consecutive series of craniopharyngiomas operated on through an endonasal endoscopic approach. Patients younger than 18 years, those requiring concurrent craniotomy, and those with incomplete pre- and postoperative survey panels were excluded from the study.

Results: Eleven patients had complete survey sets. The mean age for the cohort was 47 years, with 36% having undergone prior surgery. No change in ASBQ score was observed at 3 weeks, 6 weeks, 6 months, or 1 year after the surgery (P > 0.05). Seven patients (64%) experienced persistent postoperative diabetes insipidus, and seven (64%) patients developed panhypopituitarism. No significant change was evident in SNOT-22 scores at any postoperative time point (P > 0.05). Gross total resection was achieved in 64% of cases, with fluorescein-detectable intraoperative CSF leak present in all cases. Vascularized nasoseptal flap closure and gasket-seal reconstruction were used in all cases. Furthermore, the use of nasoseptal flap did not contribute to decreased QOL on either scale. No postoperative CSF leak was observed. The cohort was not burdened by any significant morbidity or mortality.

Conclusions: Endoscopic resection of craniopharyngiomas is associated with stable sinonasal and site-specific QOL when assessed pre- and postoperatively with validated instruments. The endoscopic approach thus proves to be a viable option for the surgical management of selected craniopharyngiomas that contributes to maintenance of patient perception of well-being despite postoperative endocrine abnormalities.