Impact of Previous Craniotomy on Subsequent Endoscopic Endonasal Resection of Recurrent Craniopharyngioma: A Multicenter Retrospective Study

Introduction: Few studies have examined the impact of prior craniotomy on subsequent endonasal surgery for recurrent craniopharyngiomas. The authors report the outcomes of repeat surgical resection via the endoscopic endonasal approach (EEA) for recurrent craniopharyngiomas that were previously resected via a transcranial approach performed at 3 centers.

Methods: The authors conducted a retrospective review of 46 patients who underwent EEA for recurrent craniopharyngioma that were previously resected through a craniotomy. Patients were evaluated for tumor size, previous treatments, extent of resection, visual and endocrine outcomes, complications and recurrence rates.

Results: There were 24 males and 22 females with a mean age of 32.9 years (range: 4–63) and mean follow-up of 33 months. Thirty-three percent of the patients had multiple craniotomies, and 35% underwent radiation prior to the EEA. The mean diameter of the recurrent tumor was 22.6 mm (range: 7–49 mm) and 91% were suprasellar. Gross-total resection was achieved in 70%, near-total resection in 15%, and subtotal resection in 15% of cases. Postoperatively, 98% of the cases had unchanged or improved vision and only one patient (2%) had worsened vision. Of the 7 patients with either normal or some residual anterior pituitary function preoperatively, new anterior hypopituitarism developed in 5 patients (71%) and 7 patients (50%) out of the 14 patients with no diabetes insipidus preoperatively developed new diabetes insipidus. The rate of CSF leakage was 2% and the rate of infection was 15%. Adjuvant radiation was given in 26% of the cases and the tumor recurrence was 17%.

Conclusion: EEA can safely achieve maximal resection of recurrent craniopharyngiomas and provide excellent visual and endocrine outcomes following a previous transcranial approach. Outcomes did not appear to be significantly impacted by the number of previous craniotomies, type of craniotomy, tumor size, tumor location, or previous radiation.