title: Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery.
abstract: OBJECTIVE
  To analyze surgical outcomes in 90 patients with craniopharyngioma treated by standard transsphenoidal surgery (TSS) or extended transsphenoidal surgery (eTSS).
  
  
  METHODS
  From 1990-2008, 90 patients (64 adults and 26 children) underwent TSS for craniopharyngioma (34 subdiaphragmatic and 56 supradiaphragmatic). TSS was performed as the initial surgery in 62 patients and as the second procedure in 28 patients.
  
  
  RESULTS
  Total tumor removal was achieved in 70 (77.8%) patients, subtotal removal was achieved in 17 (18.9%), and partial removal was achieved in 3 (3.3%). Total removal was more often accomplished in initial surgery (56 of 62 [90.3%]) than second surgery (14 of 28 [50.0%]). Postoperative deterioration of anterior pituitary hormones developed in 31 of 47 (66.0%) patients with preoperative normal function or partial anterior pituitary loss. New-onset postoperative diabetes insipidus (DI) developed in 35 of 67 (52.2%) patients. Of 61 patients with preoperative visual loss, 55 (90.2%) noted some degree of visual improvement after surgery. The early postoperative mortality rate was 2.2% (2 of 90 patients). Cerebrospinal fluid (CSF) leakage occurred in 11 patients (12.2%), and 5 patients required surgical repair of the leak. Tumor recurrence was observed in seven (7.8%) patients during a mean follow-up period of 4.6 years.
  
  
  CONCLUSIONS
  Most craniopharyngiomas including the supradiaphragmatic type can be removed safely by TSS with a good outcome, although endocrine function frequently worsens after surgery. Dural fascia graft is a very effective technique to prevent CSF leaks, especially after eTSS.
authors.affiliation: Department of Hypothalamic & Pituitary Surgery, Toranomon Hospital, Tokyo, Japan. syamadays11@hotmail.com
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Noriaki
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oyama
authors.forename: Akira
authors.initials: A
authors.lastname: Takeshita
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Junko
authors.initials: J
authors.lastname: Ito
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000134:cerebrospinal fluid / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000134:cerebrospinal fluid / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D013100:Sphenoid Bone / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014787:Vision Tests; D014785:Vision, Ocular; D055815:Young Adult
chemical_list: D006728:Hormones