Endoscopic Endonasal Approach for Residual and Recurrent Craniopharyngioma after Transcranial Approach

Objectives: While the endoscopic endonasal approach (EEA) has become a well-established option for resection of craniopharyngiomas (CP), the utility of this procedure following prior open transcranial approach (TCA) surgery has been studied to a limited degree. Here, we present a multi-institutional case series of patients who underwent EEA for resection of recurrent or progressive CP after previous TCA to investigate the endocrinologic and visual outcomes achieved as well as the associated complication rate.

Design: Retrospective cohort.

Setting: University of Pittsburgh Medical Center and Loyola University Medical Center.

Participants: Patients who underwent EEA for recurrent or progressive CP following an initial TCA over a 15-year period between 2003 and 2018.

Primary Outcome Measures: Surgical complications, visual outcomes, and endocrine outcomes.

Results: Thirteen patients met inclusion criteria. Three patients had incomplete medical records from outside facilities at which TCA was performed and therefore could not undergo evaluation of outcomes and complication rates from TCA. Analysis revealed that EEA was not associated with worsening of visual outcomes as compared with the initial TCA (0% worsened vision postoperatively after EEA vs. 40% after initial TCA, p = 0.055). While primary TCA resulted in worsening endocrinopathies in 100% of patients, subsequent EEA achieved stable (30.8%) to improved (69.2%) endocrine function in all patients; this difference vs primary TCA was statistically significant (p < 0.001). Five (50%) of patients experienced postoperative complications after TCA, whereas two (15.4%) experienced complications after EEA (one CSF leak and one sphenoid sinus infection).

Conclusions: EEA showed efficacy and safety for the resection of recurrent CP after a prior TCA. Endocrinologic and visual outcomes were stable to improved after EEA in all patients evaluated in this study. We conclude that EEA should be considered for re-resection in cases of progressive or recurrent CP following prior TCA.

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Artikel online veröffentlicht:
01. Februar 2023