Comparative Analysis of Endoscopic Endonasal versus Open Transcranial Microsurgery for Resection of Craniopharyngiomas: A Single-Institution 20-Year Experience

Introduction: Craniopharyngioma is a rare, benign tumor, originating from the remnants of the craniopharyngeal duct. Historically treated via the open transcranial approach (OTC), the endoscopic endonasal approach (EEA) has been adopted in recent years as the preferred method. However, consensus on clinical or radiographic features to guide approach selection is lacking.

Objective: The purpose of this study was to identify differences in surgical outcomes for patients undergoing OTC or EEA for primary resection of craniopharyngioma at a single institution over 20 years.

Methods: A retrospective review of all patients who underwent OTC or EEA for histopathologically confirmed craniopharyngioma at our institution between 2000 and 2022 was performed. Recurrent cases and nonsurgical patients were excluded. Preoperative patient demographics, endocrine status, presenting symptoms, and tumor volume and consistency were collected. Extent of resection, histopathological subtype, and postoperative complications were recorded. Chi-squared tests of independence were performed.

Results: A total of 232 patients were identified, of which 61 were included for preliminary analysis with fully available data. Thirty-five (57.4%) patients underwent EEA, whereas 27 (44.3%) underwent OTC. Most craniopharyngiomas were adamantinomatous (n = 33, 55.0%) and primarily cystic (n = 24, 43.6%). The stalk was sacrificed in 18.0% (n = 11) of cases. The EEA group had significantly higher rates of gross total resection compared with the OTC group (73.3 vs. 28.0%) (p < 0.001). However, rates of postoperative diabetes insipidus (81.8 vs. 76.0%), panhypopituitarism (71.9 vs. 76.2%), recurrence (20.6 vs. 25.0%), and mortality (2.9 vs. 15.4%) did not differ significantly between the EEA and OTC groups, respectively (p > 0.05).

Conclusion: Our preliminary results indicate that the EEA is better for achieving GTR, but this does not translate to superior endocrinological and survival outcomes when compared with the OTC.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025