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J Neurol Surg B Skull Base 2023; 84(04): 375-383
DOI: 10.1055/s-0042-1751291
Original Article

Evolution of Surgical Outcomes in Endoscopic Endonasal Resection of Craniopharyngiomas

Siyuan Yu
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Mohammad Taghvaei
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Maikerly Reyes
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Sarah Collopy
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Keenan Piper
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Michael Karsy 
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Giyarpuram N. Prashant
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Varun R. Kshettry 
3   Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Marc R. Rosen
2   Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Christopher J. Farrell
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
James J. Evans
1   Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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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 31st annual NASBS meeting on February 19th, 2022 in Phoenix, Arizona.




Publication History

Received: 04 May 2022

Accepted: 01 June 2022

Article published online:
15 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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