Endoscopic Endonasal Surgery for Craniopharyngiomas: A Series of 60 Patients

Jiamin Mou; Xiaoshu Wang; Gang Huo; Lunliang Ruan; Kai Jin; Song Tan; Fuchao Wang; Huang Hua; Gang Yang

doi:10.1016/j.wneu.2018.12.110

Endoscopic Endonasal Surgery for Craniopharyngiomas: A Series of 60 Patients

World Neurosurg. 2019 Apr:124:e424-e430. doi: 10.1016/j.wneu.2018.12.110. Epub 2019 Jan 3.

Authors

Jiamin Mou¹, Xiaoshu Wang¹, Gang Huo¹, Lunliang Ruan¹, Kai Jin¹, Song Tan¹, Fuchao Wang¹, Huang Hua¹, Gang Yang²

Affiliations

¹ Department of Neurosurgery, First Affiliated Hospital, Chongqing Medical University, Yuzhong District, Chongqing, P.R. China.
² Department of Neurosurgery, First Affiliated Hospital, Chongqing Medical University, Yuzhong District, Chongqing, P.R. China. Electronic address: yg_angcq@163.com.

PMID: 30610976
DOI: 10.1016/j.wneu.2018.12.110

Abstract

Objective: To report our experience of the management of 60 patients with craniopharyngioma with endoscopic endonasal surgery (EES) and evaluate the feasibility and safety of EES for craniopharyngiomas.

Methods: The clinical data of 60 patients with craniopharyngioma who underwent EES between November 2014 and December 2017 were analyzed retrospectively. All patients had vascularized nasoseptal flaps, and the most recent 4 patients had "in situ bone flaps" for better skull base reconstruction. Visual improvements, tumor resection extents, recurrence rates, endocrine functional changes, and surgical complications were evaluated.

Results: The resection rates were as follows: gross total, 68.3% (41 patients); near total (>95% of tumor removed), 15% (9 patients); subtotal (≥80% of tumor removed), 10% (6 patients); and partial (partial resection <80% of tumor removed), 6.7% (4 patients). Fifty-two patients presented with visual impairment; of these, 46 (88.5%) improved or returned to normal after surgery. Regarding the 32 patients with hypopituitarism before surgery, pituitary function was unchanged in 15 (46.8%), improved or normalized in 4 (12.5%), and deteriorated in 13 (40.6%). Eleven patients (18.3%) suffered from diabetes insipidus before treatment, and 27 more patients had this condition after surgery. Twenty-two patients had hyposmia postoperatively, and 17 patients experienced significant weight gain. Four patients had recent memory loss, and 2 of them had a temporary recent mental disorder. Three (5%) patients had cerebro-spinal fluid leakage after surgery. Three patients (5%) contracted meningitis and were cured with antibiotic treatment. One patient showed recurrence by magnetic resonance imaging re-examination, at the mean follow-up time of 22 months (range, 8-45 months; standard deviation, 11 months).

Conclusions: EES can provide surgeons with excellent exposure and can achieve a high extent of removal of most craniopharyngiomas, even those with intraventricular extensions, In our view, vascularized pedicled septal flaps and in situ bony flaps were used in skull base reconstruction.

Keywords: Craniopharyngiomas; Endoscopy extended endonasal approach; In situ bone flap.