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Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis.

TitleEndoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis.
Publication TypeJournal Article
Year of Publication2016
AuthorsMoussazadeh N, Prabhu V, Bander ED, Cusic RC, Tsiouris AJohn, Anand VK, Schwartz TH
JournalNeurosurg Focus
Volume41
Issue6
PaginationE7
Date Published2016 Dec
ISSN1092-0684
KeywordsAdult, Aged, Craniopharyngioma, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nasal Cavity, Neuroendoscopy, Neurosurgical Procedures, Pituitary Neoplasms
Abstract

OBJECTIVE The authors compared clinical and radiological outcomes after resection of midline craniopharyngiomas via an endoscopic endonasal approach (EEA) versus an open transcranial approach (TCA) at a single institution in a series in which the tumors were selected to be equally amenable to gross-total resection (GTR) with either approach. METHODS A single-institution retrospective review of previously untreated adult midline craniopharyngiomas was performed. Lesions were evaluated by 4 neurosurgeons blinded to the actual approach used to identify cases that were equally amenable to GTR using either an EEA or TCA. Radiological and clinical outcome data were assessed. RESULTS Twenty-six cases amenable to either approach were identified, 21 EEA and 5 TCA. Cases involving tumors that were resected via a TCA had a trend toward larger diameter (p = 0.10) but were otherwise equivalent in preoperative clinical and radiological characteristics. GTR was achieved in a greater proportion of cases removed with an EEA than a TCA (90% vs 40%, respectively; p = 0.009). Endoscopic resection was associated with superior visual restoration (63% vs 0%; p < 0.05), a decreased incidence of recurrence (p < 0.001), lower increase in FLAIR signal postoperatively (-0.16 ± 4.6 cm vs 14.4 ± 14.0 cm; p < 0.001), and fewer complications (20% vs 80% of patients; p < 0.001). Significantly more TCA patients suffered postoperative cognitive loss (80% vs 0; p < 0.0001). CONCLUSIONS An EEA is a safe and effective approach to suprasellar craniopharyngiomas amenable to GTR. For this select group of cases, the EEA may provide higher rates of GTR and visual improvement with fewer complications compared with a TCA.

DOI10.3171/2016.9.FOCUS16299
Alternate JournalNeurosurg Focus
PubMed ID27903116