Clinical Outcome after Extended Endoscopic Endonasal Resection of Craniopharyngiomas: Two-institution Experience

• Published in: World neurosurgery Vol. 103; pp. 465 - 474
• Main Authors: Park, Hye Ran, MD, Kshettry, Varun R., MD, Farrell, Christopher J., MD, Lee, Jae Meen, MD, Kim, Yong Hwy, MD, Won, Tae Bin, MD, Han, Doo Hee, MD, Do, Hyunwoo, MD, Nyguist, Gurston, MD, Rosen, Marc, MD, Kim, Dong Gyu, MD, Evans, James J., MD, Paek, Sun Ha, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2017
• Subjects: Adolescent; Adult; Aged; Craniopharyngioma; Craniopharyngioma - complications; Craniopharyngioma - physiopathology; Craniopharyngioma - surgery; Diabetes Insipidus - epidemiology; Diabetes Insipidus - etiology; Disease-Free Survival; Endocrine; Endonasal; Endoscopic; Female; Humans; Hyperprolactinemia - etiology; Hypopituitarism - epidemiology; Hypopituitarism - etiology; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm, Residual; Neuroendoscopy - methods; Neurosurgery; Neurosurgical Procedures; Pituitary Irradiation; Pituitary Neoplasms - physiopathology; Pituitary Neoplasms - surgery; Postoperative Complications - epidemiology; Radiotherapy, Adjuvant; Retrospective Studies; Transnasal outcome; Transsphenoidal; Treatment Outcome; Vision Disorders - etiology; Visual Fields; Young Adult; endonasal; magnetic resonance imaging; GTR; DI; MRI; subtotal resection; ACTH; insulin-like growth factor-1; NTR; Seoul National University Hospital; STR; ANOVA; CSF; transnasal; FSH; growth hormone; SNU; Thomas Jefferson University Hospital; outcome; desmopressin; TJU; endocrine; BMI; computed tomography; EEA; GH; follicle-stimulating hormone; gross total resection; DDAVP; diabetes insipidus; body mass index; near total resection; TSH; adrenocorticotropin hormone; IGF-1; analysis of Variance; luteinizing hormone; transsphenoidal; endoscopic; thyroid-stimulating hormone; CT; endoscopic endonasal surgery; EES; craniopharyngioma; cerebrospinal fluid; endoscopic endonasal approach; LH; Endocrine; Transsphenoidal; Craniopharyngioma; Transnasal outcome; Endonasal; Endoscopic
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.047

Abstract Background The extended endoscopic endonasal approach (EEA) to the anterior cranial base is used for the resection of craniopharyngiomas. Objective We present clinical experience and outcomes utilizing EEA for craniopharyngiomas. Methods A total of 116 patients in two remote institutions were enrolled in this retrospective study. Surgical, endocrinological and ophthalmological outcomes were assessed. Results The mean follow-up was 35 months (range, 1–115). Gross total resection (GTR), near total resection (NTR, >95%), and subtotal resection (STR) were achieved in 46%, 39%, and 15% of the patients, respectively. Surgery performed after 2010 was the only variable significantly associated with greater extent of resection, which might be explained by the learning curve. Overall tumor recurrence rate was 15.5%, with a median interval until recurrence of 14.5 months (range, 3–58). Extent of resection was significantly associated with recurrence-free survival ( P =0.0116). Those who underwent NTR/STR followed by adjuvant radiotherapy had a similar median recurrence-free survival rate compared to those that underwent GTR (26.5 vs 20 months, P =0.167). Endocrinological examination revealed that 47.4% of patients experienced worsening of anterior pituitary function following surgery while 25.5% developed new-onset diabetes insipidus. Of the 89 patients with preoperative visual deficits, 68 (76.4%) experienced improvement in visual field assessment. Conclusion EEA is effective for the surgical resection of craniopharyngiomas, resulting in high rates of visual improvement and low complication rates. Adjuvant radiotherapy is a useful method for tumor control after incomplete resection.