title: Microsurgical Management of Craniopharyngiomas via a Unilateral Subfrontal Approach: A Retrospective Study of 177 Continuous Cases.
abstract: OBJECTIVE
  To evaluate the outcomes of 177 cases of craniopharyngioma (CP) treated via a unilateral subfrontal approach.
  
  
  METHODS
  A total of 177 continuous microscopic surgeries were performed by the senior author (Y.X.). The tumors were divided into 6 groups using the diaphragm sellae and the third ventricle floor as the anatomic references. The preoperative, postoperative, and long-term follow-up data were analyzed to evaluate the extent of tumor resection, recurrence, and functional status.
  
  
  RESULTS
  The subfrontal-basal approach was used in 169 (91.4%) cases. Total resection was achieved in 167 (94.4%) cases. A total of 158 patients were followed from 6 to 130 months. There were 3 perioperative and 23 delayed deaths. Twenty-two patients had tumor recurrence (12.7%). The progression-free survival was 80% at 5 years and 72% at 10 years. The overall survival was 84.0% at 2.5 years and 83.2% at 10 years. There was a significant increase of pituitary dysfunction after total resection. Neurologic function was stable in most patients. Rate of hypothalamic dysfunction and mortality were higher in patients with intraventricular CPs. Of the surviving patients, 91.8% were living independently with acceptable morbidities at the end of the study.
  
  
  CONCLUSIONS
  Most CPs extend along the intrasellar-suprasellar-third ventricle axis. A subfrontal-basal approach is a simple, safe, and effective approach to resecting CPs extending along the vertical axis. A translamina terminalis approach is an ideal corridor to resect intraventricular CP. The benefit of radical resection remains controversial, especially for CPs involving the infundibulotuberal region.
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Can
authors.initials: C
authors.lastname: Du
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Feng
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China. Electronic address: xry69@163.com.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Yuan
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Liu
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Ze-Feng
authors.initials: ZF
authors.lastname: Peng
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xing-Jun
authors.initials: XJ
authors.lastname: Jiang
authors.affiliation: The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Ge-Lei
authors.initials: GL
authors.lastname: Xiao
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xiong
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Craniopharyngioma; Gross total resection; Lamina terminalis; Microsurgery; Quality of life; Retrochiasmatic; Subfrontal approach; Third ventricle