Extended Endoscopic Transsphenoidal Surgery for Suprasellar Craniopharyngiomas

Material and Methods: In the past 7 years, 204 patients with different purely supradiaphragmatic tumors (craniopharyngiomas, anterior scull base meningiomas, chiasmal and III ventricular gliomas, cholesteatomas, some pituitary adenomas, cavernomas) underwent removal via extended endoscopic transsphenoidal transplanum transtuberculum approach. Most of the patients (139 patients) were with craniopharyngiomas (suprasellar, intraventricular). Five patients with craniopharyngiomas had been treated different transcranial approach previously. The operation is always performed through bilateral endonasal approach with endoscope as the only instrument of visualization. Results: Total tumor removal was achieved in 67.6%. Vision symptoms improved significantly in 46% patients, 9.3% patients worsening vision after surgery. Endocrine dysfunction did not improve after surgery, and endocrine dysfunctions (hypopituitarism and diabetes insipidus) increase after operations in 36% cases. Other main complications: bacterial meningitis (11.5%), CSF leaks (9.4%), mental disorder (2%). Recurrence rate was 12%. Lethality was 5%. Mean follow-up period was 36 months. Conclusion: The endoscopic extended transsphenoidal approach for suprasellar craniopharyngiomas may be a really alternative to the transcranial approach in many cases. The data obtained by us suggest, that extraction of suprasellar craniopharyngiomas in extended transsphenoidal approach is a significantly more effective and less traumatic technology, able to provide both eradication of tumor along with high quality of life after surgery, and relatively small values of postoperative complications and lethality.