title: Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas.
abstract: OBJECTIVE
  The endoscopic extended transsphenoidal approach for suprasellar craniopharyngiomas may be a really alternative to the transcranial approach in many cases. The authors present their experience with this technique in 136 patients with craniopharyngiomas.
  
  
  METHODS
  From the past 7 years 204 patients with different purely supradiaphragmatic tumors underwent removal by extended endoscopic transsphenoidal transtuberculum transplanum approach. Most of the patients (136) had craniopharyngiomas (suprasellar, intra-extraventricular). The patients were analyzed according to age, sex, tumor size, growth and tumor structure, and clinical symptoms. Twenty-five patients had undergone a previous surgery. The mean follow-up was 42 months (range, 4-120 months). The operation is always performed with the bilateral endoscopic endonasal anterior extended transsphenoidal approach.
  
  
  RESULTS
  A gross-total removal was completed in 72%. Improvement of vision or absence of visual deterioration after operation was observed in 89% of patients; 11% had worsening vision after surgery. Endocrine dysfunction did not improve after surgery, new hypotalamopituitary dysfunction (anterior pituitary dysfunction or diabetes insipidus) or worsening of it was observed in 42.6%. Other main complications included transient new mental disorder in 11%, temporary neurological postoperative deficits in 3.7%, bacterial meningitis in 16%, cerebrospinal fluid leaks in 8.8%. The recurrence rate was 20% and the lethality was 5.8%.
  
  
  CONCLUSIONS
  Resection of suprasellar craniopharyngiomas using the extended endoscopic approach is a more effective and less traumatic technology, able to provide resection of the tumor along with high quality of life after surgery, and relatively rare postoperative complications and mortality.
authors.affiliation: Department of Skull-Base Surgery, Burdenko Neurosurgical Institute, Moscow, Russia. Electronic address: dfomichev@list.ru.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Fomichev
authors.affiliation: Department of Skull-Base Surgery, Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: Pavel
authors.initials: P
authors.lastname: Kalinin
authors.affiliation: Department of Skull-Base Surgery, Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: Maxim
authors.initials: M
authors.lastname: Kutin
authors.affiliation: Department of Skull-Base Surgery, Burdenko Neurosurgical Institute, Moscow, Russia.
authors.forename: Oleg
authors.initials: O
authors.lastname: Sharipov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003397:Craniopharyngioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D044583:Neuroendoscopy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D010911:Pituitary Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D055815:Young Adult
keywords: Anterior extended transsphenoidal endoscopic endonasal approach; Craniopharyngiomas; Skull-base surgery; Transnasal approach