Endoscopic Endonasal Transsphenoidal Surgery for Recurrent Craniopharyngiomas

Zhenguang Feng; Chuzhong Li; Lei Cao; Ning Qiao; Wentao Wu; Jiwei Bai; Peng Zhao; Songbai Gui

doi:10.3389/fneur.2022.847418

Endoscopic Endonasal Transsphenoidal Surgery for Recurrent Craniopharyngiomas

Front Neurol. 2022 Apr 11:13:847418. doi: 10.3389/fneur.2022.847418. eCollection 2022.

Authors

Zhenguang Feng¹, Chuzhong Li², Lei Cao³, Ning Qiao³, Wentao Wu³, Jiwei Bai³, Peng Zhao³, Songbai Gui³

Affiliations

¹ Department of Neurosurgery, Tianjin First Center Hospital, Tianjin, China.
² Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Abstract

Object: Although revision surgery for recurrent craniopharyngiomas is more challenging than primary surgery and often accompanies a higher risk of death and complications, endoscopic endonasal transsphenoidal surgery (EETS) is sometimes still an effective and reliable treatment option. In this study, we introduced the surgical outcomes of EETS for recurrent craniopharyngiomas and summarized the surgical experiences.

Methods: Between 2014 and 2018, 28 patients with recurrent craniopharyngiomas underwent 29 EETS in our department. We regarded the patient undergoing two EETS as two independent patients in statistical analysis. Of the 29 patients, 16 had undergone 1 previous surgery, 10 had undergone 2 previous surgeries, and the remaining 3 patients had undergone 3 surgeries. The extent of resection, visual and endocrine outcomes, and complications of all the patients were collected and analyzed.

Results: Gross total resection was accomplished in 16 patients (55.17%), subtotal resection in 11 patients (37.93%), and partial resection in 2 patients (6.9%). Among the 22 patients with preoperative visual acuity and visual field impairment, some degree of vision improvement was observed in 18 patients, 3 patients were without visual change, and perpetual deterioration of vision occurred in one patient. The remaining six patients had normal vision before and after surgery. Postoperative endocrine tests showed that, among five patients with normal preoperative pituitary hormone function, only one patient still had normal pituitary hormone function and the other four patients had one or more hypothalamic-pituitary axes involved. None of the patients with preoperative endocrine dysfunction had endocrine function improved. Diabetes insipidus was observed in six new cases postoperatively. Cerebrospinal fluid (CSF) leakage occurred in 1 patient. One patient had bacterial meningitis, which was cured with antibiotics and a lumbar drain. No serious morbidity and mortality occurred in all patients.

Conclusions: For recurrent craniopharyngiomas, a personalized treatment plan should be developed according to the tumor characteristics and the patient's situation. There is no omnipotent method to be used for all patients. The EETS still is a safe and effective way to treat recurrent craniopharyngiomas in appropriate patients.

Keywords: craniopharyngiomas; endocrine; endoscopic endonasal transsphenoidal; recurrent; surgical treatment.