Endonasal endoscopic surgical treatment of craniopharyngiomas in adult patients. Our experience

Authors

DOI:

https://doi.org/10.25305/unj.289359

Keywords:

craniopharyngioma, endonasal endoscopic approach, skull base defect closure, pituitary transposition, pituitary hemitransposition, transtuberculum approach, postoperative CSF leak, hypopituitarism

Abstract

Objective: to estimate the results of surgical treatment of adult patients with craniopharyngiomas (CP), who underwent endoscopic endonasal surgical treatment.

Materials and methods. Treatment of 69 adult patients with CPs who underwent endonasal endoscopic surgery from 2014 to 2021 is described. Gender division: women 42% (60.9%), men 27 (39.1%). The minimum age of patients is 19 years (women 19, men 20), the maximum age is 73 years (women 73, men 66). The mean age of all patients in the group was 46.7±14.5 years, women 47.6±15.5 years, men 45.1±12.6 years. In 52 patients (75.4%) the surgical intervention was primary, and in 17 patients (24.6%) it was secondary. All patients were estimated for preoperative and postoperative endocrine and neuro-ophthalmological status in dynamics.

Results. No hemorrhagic or access-associated complications have been reported. Major complications: postoperative CSF leak - 9 patients (13%), meningitis - 10 patients (14.5%), 7 out of 8 patients with CSF leak had meningitis. 7 out of 10 patients with meningitis also had CSF leak. Other complications: acute tension pneumocephalus (2 cases, 2.9%), electrolyte disturbances (45 cases, 65.2%), severe diencephalic dysfunction (SDD) (4 cases, 5.8%). The postoperative mortality rate was 3 cases (4.35%), of which 1 due to meningitis (33.3% of all deaths), due to SDD 2 cases (66.6%). The dynamic changes of visual function were as follows: improvement in 36 patients (66.7% of all patients with preoperative visual impairment), no significant change in 7 patients (13%), deterioration in 10 patients (18.5%), 4 of which were transient. 40 patients had hypopituitarism prior to surgery, 10 of whom also had diabetes insipidus. A worsening of hypopituitarism was observed in 13 patients (32.5% of all patients with preoperative hypopituitarism) and an onset of hypopituitarism in 18 patients (26.1%). The onset of diabetes insipidus in the postoperative period occurred in 23 patients (33.3%), 7 of whom with regression.

Conclusions. Endonasal endoscopic approach is no longer an alternative for surgical treatment of certain forms of craniopharyngiomas, but it is a method of choice for most CP cases. The postoperative mortality is low. The quality of life of the operated patients is satisfactory due to a high percentage of improvement in visual function and preservation of endocrine function. The rates of CSF leak and purulent-septic complications correlate with the data of the world literature. Modern standards of treatment require the establishment of a multidisciplinary team of specialists in healthcare institutions to personalize the treatment process in patients with CPs.

References

1. Hoffman HJ. Surgical management of craniopharyngioma. Pediatr Neurosurg. 1994;21 Suppl 1:44-9. [CrossRef] [PubMed]

2. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM. The descriptive epidemiology of craniopharyngioma. Neurosurg Focus. 1997 Dec 15;3(6):e1. [CrossRef] [PubMed]

3. Lubuulwa J, Lei T. Pathological and Topographical Classification of Craniopharyngiomas: A Literature Review. J Neurol Surg Rep. 2016 Jul;77(3):e121-7. [CrossRef] [PubMed] [PubMed Central]

4. Müller HL, Merchant TE, Warmuth-Metz M, Martinez-Barbera JP, Puget S. Craniopharyngioma. Nat Rev Dis Primers. 2019 Nov 7;5(1):75. [CrossRef] [PubMed]

5. König A, Lüdecke DK, Herrmann HD. Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir (Wien). 1986;83(1-2):1-7. [CrossRef] [PubMed]

6. Laws ER Jr. Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg. 1980 May;52(5):661-6. [CrossRef] [PubMed]

7. Weiss MH. Transnasal transsphenoidal approach. In: Apuzzo MLJ, editor. Surgery of the Third Ventricle. Baltimore: Williams & Wilkins; 1987. P. 476-94.

8. Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg. 1997 Jul;87(1):44-51. [CrossRef] [PubMed]

9. Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg. 2002 Aug;97(2):293-8. [CrossRef] [PubMed]

10. Chakrabarti I, Amar AP, Couldwell W, Weiss MH. Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg. 2005 Apr;102(4):650-7. [CrossRef] [PubMed]

11. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery. 2004 Sep;55(3):539-47; discussion 547-50. [CrossRef] [PubMed]

12. Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin NA. The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg. 2005 May;102(5):832-41. [CrossRef] [PubMed]

13. Maira G, Anile C, Albanese A, Cabezas D, Pardi F, Vignati A. The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg. 2004 Mar;100(3):445-51. [CrossRef] [PubMed]

14. Kouri JG, Chen MY, Watson JC, Oldfield EH. Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg. 2000 Jun;92(6):1028-35. [CrossRef] [PubMed]

15. Kalinin PL, Fomichev DV, Kutin MA, Kadashev BA, Astaf'eva LI, Kurnosov AB, Popugaev KA, Fomochkina LA, Tropinskaia OF. Endoscopic endonasal anterior extended transsphenoidal approach in craniopharyngioma surgery. Zh Vopr Neirokhir Im N N Burdenko. 2013;77(3):13-20; discussion 20. English, Russian. [PubMed]

16. Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F. The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery. 2006 Jul;59(1 Suppl 1):ONS75-83; discussion ONS75-83. [CrossRef] [PubMed]

17. Fomichev D, Kalinin P, Kutin M, Sharipov O. Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas. World Neurosurg. 2016 Oct;94:181-187. [CrossRef] [PubMed]

18. Stamm AC, Vellutini E, Balsalobre L. Craniopharyngioma. Otolaryngol Clin North Am. 2011 Aug;44(4):937-52, viii. [CrossRef] [PubMed]

19. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg. 1999 Feb;90(2):237-50. [CrossRef] [PubMed]

20. Zoli M, Guaraldi F, Zenesini C, Acciarri N, Sollini G, Asioli S, Faustini-Fustini M, Agati R, Cirillo L, Tonon C, Lodi R, Pasquini E, Mazzatenta D. Role of endoscopic endonasal approach for craniopharyngiomas extending into the third ventricle in adults. Brain Spine. 2022 Jun 30;2:100910. [CrossRef] [PubMed] [PubMed Central]

21. Honegger J, Buchfelder M, Fahlbusch R, Däubler B, Dörr HG. Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol. 1992 Mar;37(3):189-96. [CrossRef] [PubMed]

22. Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa A, Zoli M, D'Enza AI, Esposito F, Pasquini E. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg. 2014 Jul;121(1):100-13. [CrossRef] [PubMed]

23. Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S. Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg. 2008 Jul;109(1):6-16. [CrossRef] [PubMed]

24. Honegger J, Tatagiba M. Craniopharyngioma surgery. Pituitary. 2008;11(4):361-73. [CrossRef] [PubMed]

25. Almeida JP, Workewych A, Takami H, Velasquez C, Oswari S, Asha M, Bernardo A, Gentili F. Surgical Anatomy Applied to the Resection of Craniopharyngiomas: Anatomic Compartments and Surgical Classifications. World Neurosurg. 2020 Oct;142:611-625. [CrossRef] [PubMed]

26. Tang B, Xie SH, Xiao LM, Huang GL, Wang ZG, Yang L, Yang XY, Xu S, Chen YY, Ji YQ, Zeng EM, Hong T. A novel endoscopic classification for craniopharyngioma based on its origin. Sci Rep. 2018 Jul 5;8(1):10215. [CrossRef] [PubMed] [PubMed Central]

27. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery. 2007 Nov;61(5 Suppl 2):219-27; discussion 228. [CrossRef] [PubMed]

28. Dehdashti AR, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery. 2009 Apr;64(4):677-87; discussion 687-9. [CrossRef] [PubMed]

29. Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery. 2012 Jan;70(1):110-23; discussion 123-4. [CrossRef] [PubMed]

30. Liu F, Bao Y, Qiu BH, Mao J, Mei F, Liao XX, Huang HR, Qi ST. Incidence and Possible Predictors of Sodium Disturbance After Craniopharyngioma Resection Based on QST Classification. World Neurosurg. 2021 Aug;152:e11-e22. [CrossRef] [PubMed]

Published

2023-12-26

How to Cite

Guk, M. O., & Chukov, A. A. (2023). Endonasal endoscopic surgical treatment of craniopharyngiomas in adult patients. Our experience. Ukrainian Neurosurgical Journal, 29(4), 46–56. https://doi.org/10.25305/unj.289359

Issue

Section

Original articles