Endoscopic Endonasal Surgery for Craniopharyngiomas: A Series of 60 Patients

Objective: The treatment for craniopharyngiomas has always been one of the greatest challenges to neurosurgeons. The philosophy and techniques for managing craniopharyngiomas are constantly updated. Endoscopic endonasal surgery (EES) developed rapidly for the past years, and whether it can improve the therapeutic effect for craniopharyngiomas is a hot issue. We are reporting our initial experience of 60 patients managed by EES to evaluate the feasibility and safety of EES for craniopharyngiomas.

Method: Clinical data of 60 patients with craniopharyngiomas following EES between November 2014 and December 2017 were analyzed retrospectively. All patients were used vascularized nasoseptal flap and we should highlight that in recent one year, we use “in situ bone flap” for better skull base reconstructions in 4 patients, Visual improvement, extent of tumor resection, recurrence rate, change of endocrine function and surgical complications were evaluated.

Results: Sixty patients, 36 males and 24 females, were eligible for this study. 54 adults and 6 children were included with age ranged from 12 to 69 years. The mean age was 43 years (range: 20–69 years) in the adult group, and 14 (range: 12–17) in the pediatric group. 52 patients had presented with primary craniopharyngiomas, 8 presented with recurrent tumors after transcranial surgery. Overall, the gross-total resection rate was 68.3% (41 patients); near-total resection (> 95% of tumor removed) was 15% (9 patients); subtotal resection (≥80% of tumor removed) was 10% (6 patients); and partial resection (PR< 80% of tumor removed) was 6.7% (4 patients). 52 patients presented with visual impairment. Of the 52 patients with visual impairment, 46 (88.5%) had improved or even returned to normal after surgery, while 6 had no improvement. One patient whose preoperative vision was intact experienced some degree of temporary postoperative visual deterioration of the right eye. There was no case of permanent visual deterioration. Among 32 patients with hypopituitarism before surgery, 15 (46.8%) had no change in pituitary function, 4 (12.5%) improved or normalized, and 13 (40.6%) deteriorated. In another group of 28 patients who had presented with normal pituitary function, new pituitary insufficiency was found in 18 (64.2%). 11 patients (18.3%) suffered from diabetes insipidus before the treatment, and there were 27 more patients who had this condition after the surgery. 22 patients had hyposmia postoperatively and 17 patients experienced significant weight gain. Four patients had recent memory loss and two of them had temporary recent mental disorder. Three (5%) patients had CSF leakage after surgery and one of which underwent subsequent meningitis. Three patients (5%) got meningitis and cure by treatment with antibiotics. Brainstem hemorrhage occurred in one patient after surgery. One case compared with left centrum semiovale infarction. One patient recurred by MRI reexamination with a mean follow-up of 22 months (range, 8–45 months; SD, 11 months).