title: Endoscopic endonasal trans-sphenoid management of craniopharyngiomas.
abstract: BACKGROUND
  Craniopharyngiomas treatment has been challenging because of their anatomical location. The endoscopic endonasal (EE) trans-sphenoidal approach is indicated in sellar, supra sellar, selected intraventricular lesions in adults and children. We are reporting our initial experience of 44 patients managed by EE approach.
  
  
  METHODS
  This is a retrospective study of 44 craniopharyngiomas. The goal of surgery was gross-total resection in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Lumbar drain at the start of the operation was used in all cases with tumor larger than 3 cm maximum diameter. Binostril technique vascularized nasoseptal flap and multilayer closure of the dural defect were used. Wide sphenoidotomy, posterior ethmoidectomy, tuberculum selle, and planum removal were performed in all cases. Perioperative antibiotic prophylaxis was used for 72 h.
  
  
  RESULTS
  There were 44 patients of age ranging from 8 to 65 (mean: 42) years. Diameter of the tumor varied from 3.1 cm to 6.6 cm (average: 4.3 cm). Visual and pituitary dysfunctions were observed in 44 and 33, respectively, before surgery. Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively. Average follow-up was 19 months.
  
  
  CONCLUSIONS
  Endoscopic endonasal trans-sphenoidal approach for craniopharyngioma is safe and effective alternative to transcranial approach in selected patients. Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.
authors.affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Yad Ram
authors.initials: YR
authors.lastname: Yadav
authors.affiliation: Department of Radiodiagnosis and Imaging All India Institute of Medical Science, New Delhi, India.
authors.forename: Yadav
authors.initials: Y
authors.lastname: Nishtha
authors.affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Parihar
authors.initials: P
authors.lastname: Vijay
authors.affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Ratre
authors.initials: R
authors.lastname: Shailendra
authors.affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
authors.forename: Kher
authors.initials: K
authors.lastname: Yatin
keywords: Brain neoplasm; craniopharyngioma; endoscopy; intracranial neoplasm; neoplasm; surgical endoscopy