Endonasal Transsphenoidal Surgery of Craniopharyngiomas: Two-Center Experience

Objective: To present the results of transnasal surgery of craniopharyngiomas. Methods: A retrospective review including surgical technique, extent of resection, complications and outcomes was performed. All patients were operated between 2007 and 2015 in two medical center. Results: Twenty patients with craniopharyngiomas were operated. Transnasal microsurgical approach was performed in 3 (15%) cases, and endonasal endoscopic approach (EEA) was applied at 17 (85%) patients respectively. In 11 cases of them a suprasellar expanded approach was performed. There were 7 males and 13 females. Patient's age was between 16 and 76 years. Three patients required a repeat surgery due to residual tumor progression in the period of 6 to 57 months postoperatively. Gross-total resection was achieved in nine patients (45%), near total in five (25%), subtotal in five (25%), and partial in one (5%). All patients with gross-total resection have no signs of tumor recurrence at follow-up (mean period: 30.7 months). Sixteen patients has a visual disturbances, 12 (75%) of them improved, 3 (18.75%) remained unchanged, and 1 (6.25%) developed new deficit postoperatively. A postoperative CSF-leak occurred in 9 (45%) patients and was a reason of meningitis in 3 (15%) of them. Eight patients underwent a surgical reconstruction of CSF-fistula, one case of CSF-leak resolved on lumbar drain. Seven patients (35%) developed a diabetes insipidus, 4 (20%) showed a panhypopituitarism, and 1 (5%) patient had a cerebral salt-wasting syndrome postoperatively. The mortality rate in series was zero. Conclusion: Expanded EEA for craniopharyngiomas is effective and safe especially in cases with suprasellar extension due to best illumination and wide exposure of skull-base structures.