Evolution of Surgical Outcomes in Endoscopic Endonasal Resection of Craniopharyngiomas

Abstract

Introduction Wide variations exist in the management of craniopharyngiomas, including pituitary stalk preservation/sacrifice. This study examines the practice patterns over 16 years using the endoscopic endonasal approach for the resection of craniopharyngiomas and it examines the effects of stalk preservation.

Methods Retrospective analysis was conducted for 66 patients who underwent endoscopic transsphenoidal surgery for resection of craniopharyngiomas. Patients were stratified into three epochs: 2005 to 2009 (N = 20), 2010 to 2015 (N = 23), and 2016 to 2020 (N = 20), to examine the evolution of surgical outcomes. Subgroup analysis between stalk preservation/stalk sacrifice was conducted for rate of gross total resection, anterior pituitary function preservation, and development of new permanent diabetes insipidus.

Results Gross total resection rates across the first, second, and third epochs were 20, 65, and 52%, respectively (p = 0.042). Stalk preservation across epochs were 100, 5.9, and 52.6% (p = 0.0001). New permanent diabetes insipidus did not significantly change across epochs (37.5, 68.4, 71.4%; p = 0.078). Preservation of normal endocrine function across epochs was 25, 0, and 23.8%; (p = 0.001). Postoperative cerebrospinal fluid (CSF) leaks significantly decreased over time (40, 4.5, and 0%; [p = 0.0001]). Stalk preservation group retained higher normal endocrine function (40.9 vs. 0%; p = 0.001) and less normal-preoperative to postoperative panhypopituitarism (18.4 vs. 56%; p = 0.001). Stalk sacrifice group achieved higher GTR (70.8 vs. 28%, p = 0.005). At last follow-up, there was no difference in recurrence/progression rates between the two groups.

Conclusion There is a continuous evolution in the management of craniopharyngiomas. Gross total resection, higher rates of pituitary stalk and hormonal preservation, and low rates of postoperative CSF leak can be achieved with increased surgical experience.

Keywords

craniopharyngioma - endoscopic - pituitary stalk - stalk sacrifice - learning curve

Previous Presentation

This manuscript was presented as a podium presentation at the 31^st annual NASBS meeting on February 19^th, 2022 in Phoenix, Arizona.

Publikationsverlauf

Eingereicht: 04. Mai 2022

Angenommen: 01. Juni 2022

Artikel online veröffentlicht:
15. Juli 2022

• References

• 1 Momin AA, Recinos MA, Cioffi G. et al. Descriptive epidemiology of craniopharyngiomas in the United States. Pituitary 2021; 24 (04) 517-522
• 2 Kshettry VR, Do H, Elshazly K. et al. The learning curve in endoscopic endonasal resection of craniopharyngiomas. Neurosurg Focus 2016; 41 (06) E9
• 3 Karavitaki N, Cudlip S, Adams CB, Wass JA. Craniopharyngiomas. Endocr Rev 2006; 27 (04) 371-397
• 4 Varlotto J, DiMaio C, Grassberger C. et al. Multi-modality management of craniopharyngioma: a review of various treatments and their outcomes. Neurooncol Pract 2016; 3 (03) 173-187
• 5 Ordóñez-Rubiano EG, Forbes JA, Morgenstern PF. et al. Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas. J Neurosurg 2018; 131 (04) 1-9 (e-pub ahead of print).
• 6 Fong RP, Babu CS, Schwartz TH. Endoscopic endonasal approach for craniopharyngiomas. J Neurosurg Sci 2021; 65 (02) 133-139
• 7 Almeida JP, DE Andrade EJ, Vescan A. et al. Surgical anatomy and technical nuances of the endoscopic endonasal approach to the anterior cranial fossa. J Neurosurg Sci 2021; 65 (02) 103-117
• 8 Fan J, Liu Y, Pan J. et al. Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients. J Neurosurg 2021; 135 (05) 1-12 (e-pub ahead of print).
• 9 Grewal MR, Spielman DB, Safi C. et al. Gross total versus subtotal surgical resection in the management of craniopharyngiomas. Allergy Rhinol (Providence) 2020; 11: 2152656720964158
• 10 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2012; 77 (02) 329-341
• 11 Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 1990; 73 (01) 3-11
• 12 Spoudeas HA, Saran F, Pizer B. A multimodality approach to the treatment of craniopharyngiomas avoiding hypothalamic morbidity: a UK perspective. J Pediatr Endocrinol Metab 2006; 19 (Suppl. 01) 447-451
• 13 Samii M, Tatagiba M. Surgical management of craniopharyngiomas: a review. Neurol Med Chir (Tokyo) 1997; 37 (02) 141-149
• 14 Ding H, Gu Y, Zhang X. et al. Learning curve for the endoscopic endonasal approach for suprasellar craniopharyngiomas. J Clin Neurosci 2017; 42: 209-216
• 15 Younus I, Gerges MM, Uribe-Cardenas R. et al. How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases. J Neurosurg 2020; 134 (03) 750-760
• 16 Barkhoudarian G, Laws ER. Craniopharyngioma: history. Pituitary 2013; 16 (01) 1-8
• 17 Koc K, Anik I, Ozdamar D, Cabuk B, Keskin G, Ceylan S. The learning curve in endoscopic pituitary surgery and our experience. Neurosurg Rev 2006; 29 (04) 298-305 , discussion 305
• 18 Qureshi T, Chaus F, Fogg L, Dasgupta M, Straus D, Byrne RW. Learning curve for the transsphenoidal endoscopic endonasal approach to pituitary tumors. Br J Neurosurg 2016; 30 (06) 637-642
• 19 Robins JMW, Alavi SA, Tyagi AK, Nix PA, Wilson TM, Phillips NI. The learning curve for endoscopic trans-sphenoidal resection of pituitary macroadenomas. A single institution experience, Leeds, UK. Acta Neurochir (Wien) 2018; 160 (01) 39-47
• 20 Chi F, Wang Y, Lin Y, Ge J, Qiu Y, Guo L. A learning curve of endoscopic transsphenoidal surgery for pituitary adenoma. J Craniofac Surg 2013; 24 (06) 2064-2067
• 21 Cavallo LM, Frank G, Cappabianca P. et al. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 2014; 121 (01) 100-113
• 22 QUINONES-HINOJOSA 2021 Schmidk And Sweet Operative Neurosurgical Techniques . 7th ed. Philadelphia, PA 19103-2899: ELSEVIER, 197–200
• 23 Godil SS, Tosi U, Gerges M. et al. Long-term tumor control after endoscopic endonasal resection of craniopharyngiomas: comparison of gross-total resection versus subtotal resection with radiation therapy. J Neurosurg 2021; 136 (05) 1-9 (e-pub ahead of print).
• 24 Luginbuhl AJ, Campbell PG, Evans J, Rosen M. Endoscopic repair of high-flow cranial base defects using a bilayer button. Laryngoscope 2010; 120 (05) 876-880
• 25 Müller HL. The diagnosis and treatment of craniopharyngioma. Neuroendocrinology 2020; 110 (9-10): 753-766
• 26 Tang B, Xie SH, Xiao LM. et al. A novel endoscopic classification for craniopharyngioma based on its origin. Sci Rep 2018; 8 (01) 10215
• 27 Hankinson TC, Palmeri NO, Williams SA. et al. Patterns of care for craniopharyngioma: survey of members of the American Association of Neurological Surgeons. Pediatr Neurosurg 2013; 49 (03) 131-136
• 28 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 2013; 119 (05) 1194-1207
• 29 Patel KS, Raza SM, McCoul ED. et al. Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas. J Neurosurg 2015; 123 (03) 571-580
• 30 Puget S, Garnett M, Wray A. et al. Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement. J Neurosurg 2007; 106 (Suppl. 01) 3-12
• 31 Prieto R, Pascual JM, Rosdolsky M. et al. Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors. Neurosurg Focus 2016; 41 (06) E13
• 32 Sughrue ME, Yang I, Kane AJ. et al. Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 2011; 101 (03) 463-476
• 33 Dandurand C, Sepehry AA, Asadi Lari MH, Akagami R, Gooderham P. Adult craniopharyngioma: case series, systematic review, and meta-analysis. Neurosurgery 2018; 83 (04) 631-641
• 34 Schoenfeld A, Pekmezci M, Barnes MJ. et al. The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. J Neurooncol 2012; 108 (01) 133-139
• 35 Wang EW, Zanation AM, Gardner PA. et al. ICAR: Endoscopic Skull-Base Surgery. Wiley Online Library; 2019. :145–365
• 36 Yang I, Sughrue ME, Rutkowski MJ. et al. Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 2010; 28 (04) E5
• 37 Xiao G, Yuan X, Yuan J. et al. Pituitary stalk management during the microsurgery of craniopharyngiomas. Exp Ther Med 2014; 7 (05) 1055-1064
• 38 Harrabi SB, Adeberg S, Welzel T. et al. Long term results after fractionated stereotactic radiotherapy (FSRT) in patients with craniopharyngioma: maximal tumor control with minimal side effects. Radiat Oncol 2014; 9: 203
• 39 Astradsson A, Munck Af Rosenschöld P, Feldt-Rasmussen U. et al. Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort. Acta Oncol 2017; 56 (03) 415-421