title: Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis.
abstract: OBJECTIVE The authors compared clinical and radiological outcomes after resection of midline craniopharyngiomas via an endoscopic endonasal approach (EEA) versus an open transcranial approach (TCA) at a single institution in a series in which the tumors were selected to be equally amenable to gross-total resection (GTR) with either approach. METHODS A single-institution retrospective review of previously untreated adult midline craniopharyngiomas was performed. Lesions were evaluated by 4 neurosurgeons blinded to the actual approach used to identify cases that were equally amenable to GTR using either an EEA or TCA. Radiological and clinical outcome data were assessed. RESULTS Twenty-six cases amenable to either approach were identified, 21 EEA and 5 TCA. Cases involving tumors that were resected via a TCA had a trend toward larger diameter (p = 0.10) but were otherwise equivalent in preoperative clinical and radiological characteristics. GTR was achieved in a greater proportion of cases removed with an EEA than a TCA (90% vs 40%, respectively; p = 0.009). Endoscopic resection was associated with superior visual restoration (63% vs 0%; p < 0.05), a decreased incidence of recurrence (p < 0.001), lower increase in FLAIR signal postoperatively (-0.16 ± 4.6 cm3vs 14.4 ± 14.0 cm3; p < 0.001), and fewer complications (20% vs 80% of patients; p < 0.001). Significantly more TCA patients suffered postoperative cognitive loss (80% vs 0; p < 0.0001). CONCLUSIONS An EEA is a safe and effective approach to suprasellar craniopharyngiomas amenable to GTR. For this select group of cases, the EEA may provide higher rates of GTR and visual improvement with fewer complications compared with a TCA.
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Nelson
authors.initials: N
authors.lastname: Moussazadeh
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Vishaal
authors.initials: V
authors.lastname: Prabhu
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Bander
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Cusic
authors.affiliation: Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Apostolos John
authors.initials: AJ
authors.lastname: Tsiouris
authors.affiliation: Otolaryngology.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Departments of 1 Neurological Surgery.|Otolaryngology.|Neuroscience, and.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: EEA = endoscopic endonasal approach; EOR = extent of resection; GTR = gross-total resection; TCA = transcranial approach; craniopharyngioma; endonasal; endoscope; oncology; skull base; suprasellar