title: Extended endoscopic endonasal approach for recurrent or residual adult craniopharyngiomas.
abstract: BACKGROUND
  The aim of this study was to evaluate the effectiveness of the extended endoscopic endonasal transsphenoidal approach (TSA) for recurrent or residual craniopharyngiomas, focusing on the extent of tumor resection and complications resulting from surgery at a single institution.
  
  
  METHODS
  Twelve adult patients (six men and six women) underwent extended endoscopic endonasal TSA for a recurrent or residual craniopharyngioma after a previous surgical intervention at a single institution by a single surgeon. The mean number of surgeries patients had undergone before TSA was 1.3 (range, 1-3). The mean period between patients' most recent surgery and extended TSA was 55.9 months (range, 1-184). The mean preoperative (that is, pre-extended TSA) tumor volume was 2.87 cm³. The mean follow-up period was 15.8 months (range, 4-32). We reviewed clinical and radiological features in each case, focusing on the degree of tumor resection as well as endocrinological and ophthalmological outcomes.
  
  
  RESULTS
  Gross total resection was achieved in ten patients (83.3 %), and the mean resection rate was 87 % in the other two cases. There were no significant differences between pre- and postoperative endocrine function, except in one patient who suffered postoperative panhypopituitarism resulting in pituitary stalk resection, which was necessary because of obvious tumor involvement. Three patients suffered transient diabetic insipidus (DI). With respect to ophthalmological outcomes, three patients showed improvement, two others showed decline, and the remainder showed no significant changes.
  
  
  CONCLUSIONS
  The extended endoscopic endonasal transsphenoidal approach is an effective and safe surgical approach for treating recurrent or residual craniopharyngioma.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Sung Kwon
authors.initials: SK
authors.lastname: Kim
authors.forename: Yong Hwy
authors.initials: YH
authors.lastname: Kim
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
mesh_terms: D000328:Adult; D003397:Craniopharyngioma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009666:Nose / Q000601:surgery; D010902:Pituitary Gland / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D016896:Treatment Outcome; D047368:Tumor Burden