Endoscopic Endonasal Surgery for Craniopharyngiomas: Surgical Outcome in 64 Patients

Objective: The proximity of craniopharyngiomas to vital neurovascular structures and their high recurrence rates make them one of the most challenging management dilemmas. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option both for pediatric and adult craniopharyngiomas.

Methods: We retrospectively reviewed 64 patients (47 adults, 17 children) with craniopharyngioma who underwent EES from June 1999 to April 2011. We present the results of EES for craniopharyngiomas and analyze the outcome in the two age groups.

Results: Forty-seven patients presented with primary and 17 with recurrent craniopharyngiomas. The mean age for adults was 51 years (range, 28-82 years) and 9 years for children (range, 4-18 years). The overall total and near total (>95% of tumor) resection rate was 72%, subtotal (>80% of tumor) was 21.9%, and partial (<80% of tumor) was 6.2%. Among patients who presented with pituitary insufficiency (n = 40), pituitary function remained unchanged in 19 (47.5%), improved or normalized in 8 (20%) and worsened in 13 (32.5%). In patients with normal pituitary function (n = 24), new pituitary deficit occurred in 14 (58.3%). Nineteen patients suffered from diabetes insipidus (DI) at presentation, and 21 (46.7%) developed DI after treatment. Among 44 patients with impaired vision, 38 (86.4%) had postoperative visual improvement, 5 remained unchanged and one had temporary visual deterioration. The mean follow-up was 38 months (range, 1-135 months). Recurrence after EES occurred in 22 patients (34.4%). The recurrences were more often in children and were treated with repeated surgery (n = 6), radiosurgery (n = 1), combined surgery with radiation therapy (n = 8), or interferon (n = 1). Surgical complications included cerebrospinal fluid leakage (10.6% in recent years), which was treated with surgical re-exploration (n = 13) and/or lumbar drainage placement (n = 9) and resulted in meningitis in 2 cases. Five (7.8%) cases of meningitis occurred, which were treated with antibiotics and without further complications. Postoperative hydrocephalus occurred in seven patients (12.5%) and was treated with ventriculoperitoneal shunt placement. There was no operative mortality.

Conclusions: With the goal of gross total or near total resection, EES can be employed for the treatment of every craniopharyngioma regardless of the location, size, and extension (excluding purely intraventricular tumors) and provide acceptable results, comparable to traditional craniotomies.