Surgical outcomes of endoscopic endonasal skull base surgery of craniopharyngiomas evaluated according to the degree of hypothalamic extension

Abstract Objective Sparing the hypothalamus following craniopharyngiomas treatment is a prerequisite to ensure a good quality of life. In this study, the functional prognosis of craniopharyngioma following Endoscopic endonasal skull base surgery (EES) was examined in function of the degree of hypothalamic extension. Materials and Methods Twenty cases of craniopharyngioma treated by EES were categorized according to Puget’s classification using preoperative and postoperative MRI. The degree of resection rates, symptoms amelioration, and endocrinological and hypothalamic functions were evaluated during the postoperative follow-up period. Results All cases were preoperatively classified into grades 0 (n = 8), 1 (n = 7), and 2 (n = 5). A near total resection was achieved in half of the cases. Moreover, visual improvement was observed in 75% of the cases. The incidence rate of additional endocrinological dysfunction was not related to the preoperative grade or intraoperative stalk preservation. Postoperative MRI indicated hypothalamic preservation for all grades. After an average of 60-month follow-up of 11 patients with primary tumors, four patients showed tumor regrowth controlled by stereotactic radiation therapy. All patients recorded more than 80% on the Karnofsky Performance Scale and showed no additional obesity at follow-up. Conclusion EES provides optimal resection rate and limited complications due to the preservation of the hypothalamus, regardless of the degree of preoperative hypothalamic involvement. Consequently, the rate of obesity occurrence is also decreased. This study indicates that EES protects hypothalamus function and improves tumor removal rate, and that it will become the first choice of surgical procedure for managing craniopharyngiomas.