title: Endoscopic, endonasal resection of craniopharyngiomas:  analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index.
abstract: BACKGROUND
  The endoscopic, endonasal, extended transsphenoidal approach is a minimal-access technique for managing craniopharyngiomas. Outcome measures such as return to employment and body mass index (BMI) have not been reported and are necessary for comparison with open transcranial approaches. Most prior reports of the endoscopic, endonasal approach have reported unacceptably high cerebrospinal fluid (CSF) leak rates.
  
  
  OBJECTIVE
  To assess the outcome of endoscopic, endonasal surgery in a consecutive series of craniopharyngiomas with special attention to extent of resection, CSF leak, return to employment, and BMI.
  
  
  METHODS
  Twenty-six surgeries were performed on 24 patients at Weill Cornell Medical College-New York Presbyterian Hospital. Five patients had recurrent lesions. Gross-total resection (GTR) was attempted in 21 surgeries. Indications for intended subtotal resection were advanced age, medical comorbidities, preservation of pituitary function, and hypothalamic invasion.
  
  
  RESULTS
  Mean tumor diameter was 2.9 cm. GTR (18 surgeries) or near-total (>95%) resection (2 surgeries) was achieved in 95% when GTR was the goal. Seven patients received postoperative radiation therapy. Mean follow-up was 35 months with no recurrences in GTR cases and stable disease in all patients at last follow-up. Vision improved in 77%. Diabetes insipidus and panhypopituitarism developed in 42% and 38%, respectively. A more than 9% increase in BMI occurred in 39%; 69% returned to their preoperative profession/schooling. The postoperative CSF leak rate was 3.8%.
  
  
  CONCLUSIONS
  Minimal-access, endoscopic, endonasal surgery for craniopharyngioma can achieve high rates of GTR with low rates of CSF leak. Return to employment and obesity rates are comparable to microscope-assisted transcranial and transsphenoidal reports.
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York 10065, USA.
authors.forename: Lewis Z
authors.initials: LZ
authors.lastname: Leng
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Greenfield
authors.forename: Mark M
authors.initials: MM
authors.lastname: Souweidane
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology; D003397:Craniopharyngioma / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D044583:Neuroendoscopy / Q000009:adverse effects*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010902:Pituitary Gland / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012919:Social Behavior; D016896:Treatment Outcome; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult