Hye Ran Park1, Varun R Kshettry2, Christopher J Farrell3, Jae Meen Lee4, Yong Hwy Kim4, Tae Bin Won5, Doo Hee Han5, Hyunwoo Do3, Gurston Nyguist6, Marc Rosen6, Dong Gyu Kim4, James J Evans7, Sun Ha Paek8. 1. Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. 2. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 4. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. 5. Department of Otolaryngology, Seoul National University Hospital, Seoul, Korea. 6. Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 7. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: james.evans@jefferson.edu. 8. Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. Electronic address: paeksh@snu.ac.kr.
Abstract
BACKGROUND: The extended endoscopic endonasal approach (EEA) to the anterior cranial base is used for the resection of craniopharyngiomas. OBJECTIVE: We present clinical experience and outcomes of using EEA for craniopharyngiomas. METHODS: A total of 116 patients in 2 remote institutions were enrolled in this retrospective study. Surgical, endocrinologic, and ophthalmologic outcomes were assessed. RESULTS: The mean follow-up was 35 months (range, 1-115). Gross total resection (GTR), near total resection (NTR, >95%), and subtotal resection (STR) were achieved in 46%, 39%, and 15% of the patients, respectively. Surgery performed after 2010 was the only variable significantly associated with greater extent of resection, which might be explained by the learning curve. Overall tumor recurrence rate was 15.5%, with a median interval until recurrence of 14.5 months (range, 3-58). Extent of resection was significantly associated with recurrence-free survival (P = 0.0116). Those who underwent NTR/STR followed by adjuvant radiotherapy had a similar median recurrence-free survival rate compared with those who underwent GTR (26.5 vs. 20 months, P = 0.167). Endocrinologic examination revealed that 47.4% of patients experienced worsening of anterior pituitary function following surgery while 25.5% developed new-onset diabetes insipidus. Of the 89 patients with preoperative visual deficits, 68 (76.4%) experienced improvement in visual field assessment. CONCLUSION: EEA is effective for the surgical resection of craniopharyngiomas, resulting in high rates of visual improvement and low complication rates. Adjuvant radiotherapy is a useful method for tumor control after incomplete resection.
BACKGROUND: The extended endoscopic endonasal approach (EEA) to the anterior cranial base is used for the resection of craniopharyngiomas. OBJECTIVE: We present clinical experience and outcomes of using EEA for craniopharyngiomas. METHODS: A total of 116 patients in 2 remote institutions were enrolled in this retrospective study. Surgical, endocrinologic, and ophthalmologic outcomes were assessed. RESULTS: The mean follow-up was 35 months (range, 1-115). Gross total resection (GTR), near total resection (NTR, >95%), and subtotal resection (STR) were achieved in 46%, 39%, and 15% of the patients, respectively. Surgery performed after 2010 was the only variable significantly associated with greater extent of resection, which might be explained by the learning curve. Overall tumor recurrence rate was 15.5%, with a median interval until recurrence of 14.5 months (range, 3-58). Extent of resection was significantly associated with recurrence-free survival (P = 0.0116). Those who underwent NTR/STR followed by adjuvant radiotherapy had a similar median recurrence-free survival rate compared with those who underwent GTR (26.5 vs. 20 months, P = 0.167). Endocrinologic examination revealed that 47.4% of patients experienced worsening of anterior pituitary function following surgery while 25.5% developed new-onset diabetes insipidus. Of the 89 patients with preoperative visual deficits, 68 (76.4%) experienced improvement in visual field assessment. CONCLUSION:EEA is effective for the surgical resection of craniopharyngiomas, resulting in high rates of visual improvement and low complication rates. Adjuvant radiotherapy is a useful method for tumor control after incomplete resection.