title: Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series.
abstract: OBJECTIVE
  Craniopharyngiomas are challenging tumors that most frequently occur in the sellar or suprasellar regions. Microscopic transsphenoidal resections with various extensions and variations have been performed with good results. The addition of the endoscope as well as the further expansion of the standard and extended transsphenoidal approaches has not been well evaluated for the treatment of this pathological entity.
  
  
  METHODS
  The authors performed a retrospective review of all patients who underwent a purely endoscopic, expanded endonasal approach (EEA) for the resection of craniopharyngiomas at their institution between June 1999 and February 2006. Endocrine and ophthalmological outcomes, extent of resection, and complications were evaluated.
  
  
  RESULTS
  Sixteen patients underwent endoscopic EEA for the resection of craniopharyngiomas. Five patients (31%) presented with recurrent disease. Complete resection was planned in 11 of the 16 patients. Three elderly patients with vision loss underwent planned debulking, 1 patient with vision loss and a moderate-sized tumor had express wishes for debulking, and 1 patient had a separate, third ventricular nodule that was not resected. Of those in whom complete resection was planned, 91% underwent near-total (2/11) or gross-total (8/11) resection. No patient who underwent gross-total resection suffered a recurrence. The mean follow-up period was 34 months. Of the 14 patients who presented with vision loss, 93% had improvement or complete recovery and 1 patient's condition remained stable. No patient experienced visual worsening. Eighteen percent of patients (without preexisting hypopituitarism) developed panhypopituitarism and 8% developed permanent diabetes insipidus. There were no cases of new obesity. The postoperative cerebrospinal fluid leak rate was 58%. All leaks were resolved, and there were no cases of bacterial meningitis. There was 1 vascular injury (posterior cerebral artery perforator branch) resulting in the only new neurological deficit. No patient died.
  
  
  CONCLUSIONS
  Endoscopic EEA for the resection of craniopharyngiomas provides acceptable results and holds the potential to improve outcomes.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Arlan H
authors.initials: AH
authors.lastname: Mintz
authors.forename: Steven
authors.initials: S
authors.lastname: Grahovac
authors.forename: Susan
authors.initials: S
authors.lastname: Stefko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003397:Craniopharyngioma / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome