The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients.
OBJECTIVE
Despite their benign histological appearance, craniopharyngiomas can be considered a challenge for the neurosurgeon and a possible source of poor prognosis for the patient. With the widespread use of the endoscope in endonasal surgery, this route has been proposed over the past decade as an alternative technique for the removal of craniopharyngiomas.


METHODS
The authors retrospectively analyzed data from a series of 103 patients who underwent the endoscopic endonasal approach at two institutions (Division of Neurosurgery of the Università degli Studi di Napoli Federico II, Naples, Italy, and Division of Neurosurgery of the Bellaria Hospital, Bologna, Italy), between January 1997 and December 2012, for the removal of infra- and/or supradiaphragmatic craniopharyngiomas. Twenty-nine patients (28.2%) had previously been surgically treated.


RESULTS
The authors achieved overall gross-total removal in 68.9% of the cases: 78.9% in purely infradiaphragmatic lesions and 66.3% in lesions involving the supradiaphragmatic space. Among lesions previously treated surgically, the gross-total removal rate was 62.1%. The overall improvement rate in visual disturbances was 74.7%, whereas worsening occurred in 2.5%. No new postoperative defect was noted. Worsening of the anterior pituitary function was reported in 46.2% of patients overall, and there were 38 new cases (48.1% of 79) of postoperative diabetes insipidus. The most common complication was postoperative CSF leakage; the overall rate was 14.6%, and it diminished to 4% in the last 25 procedures, thanks to improvement in reconstruction techniques. The mortality rate was 1.9%, with a mean follow-up duration of 48 months (range 3-246 months).


CONCLUSIONS
The endoscopic endonasal approach has become a valid surgical technique for the management of craniopharyngiomas. It provides an excellent corridor to infra- and supradiaphragmatic midline craniopharyngiomas, including the management of lesions extending into the third ventricle chamber. Even though indications for this approach are rigorously lesion based, the data in this study confirm its effectiveness in a large patient series.
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples;
Luigi Maria
LM
Cavallo
Giorgio
G
Frank
Paolo
P
Cappabianca
Domenico
D
Solari
Diego
D
Mazzatenta
Alessandro
A
Villa
Matteo
M
Zoli
Alfonso Iodice
AI
D'Enza
Felice
F
Esposito
Ernesto
E
Pasquini
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009666:Nose / Q000601:surgery; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
DI = diabetes insipidus; GTR = gross-total resection; PR = partial removal; QOL = quality of life; STR = subtotal resection; craniopharyngioma; diagnostic and operative techniques; endoscopic endonasal approach; endoscopy; skull base surgery; transsphenoidal surgery