Endoscopic Endonasal Approach for Residual and Recurrent Craniopharyngioma after Transcranial Approach: A Multi-institutional Experience

Abstract

Objectives While the endoscopic endonasal approach (EEA) has become a well-established surgery for resection of craniopharyngiomas (CP), the utility of this procedure following subtotal resection from open transcranial approach (TCA) surgery has yet to be explored. Here we present a multi-institutional case series of patients who underwent EEA for treatment of recurrent CP originally treated by TCA, demonstrating the viability of this approach as salvage surgery.

Design Retrospective cohort.

Setting Loyola University Medical Center and University of Pittsburgh Medical Center.

Participants Patients who underwent EEA for recurrent CP following an initial TCA between 2003 and 2018.

Main Outcome Measures Gross total resection (GTR) rate, surgical complications, visual outcomes, and endocrine outcomes

Results Patients who underwent EEA for recurrent CP following a prior TCA had a GTR rate of 77%. EEA reoperation was not associated with worsening of visual outcomes as compared with the primary TCA (0% visual worsening after EEA reoperation vs. 40% after primary TCA, p = 0.055). While primary TCA resulted in worsening endocrinopathies in 100% of patients (including seven patients with permanent diabetes insipidus), subsequent EEA for re-resection of CP resulted in stable (30.8%) or improved (69.2%) endocrine function in all patients (p < 0.001).

Conclusion EEA achieves reasonable GTR rates and is an effective, safe surgical option for recurrent CP postinitial TCA. This approach demonstrated stable or improved visual and endocrinologic outcomes in all patients within our two-institution series. Thus, EEA should be considered as an efficacious form of retreatment in cases of progressive and recurrent CP.

Keywords

craniopharyngioma - endoscopic endonasal approach - craniotomy - recurrence

Previous Presentation

Portions of the abstract of this study were presented at the 2023 North American Skull Base Society meeting (Tampa, Florida, United States, February 17, 2023) and published in the society's supplemental journal containing abstracts from presentations at the meeting.

Publikationsverlauf

Eingereicht: 22. Februar 2024

Angenommen: 04. April 2024

Accepted Manuscript online:
08. April 2024

Artikel online veröffentlicht:
03. Mai 2024

• References

• 1 Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2012; 77 (02) 329-341
• 2 Yang L, Xie SH, Fang C, Zeng EM, Tang B, Hong T. Preservation of hypothalamic function with endoscopic endonasal resection of hypothalamus-invaded craniopharyngiomas. World Neurosurg 2019; 132: e841-e851
• 3 Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 2008; 108 (04) 715-728
• 4 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 2013; 119 (05) 1194-1207
• 5 Cavallo LM, Prevedello DM, Solari D. et al. Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. J Neurosurg 2009; 111 (03) 578-589
• 6 Zenonos GA, Snyderman CH, Gardner PA. Endoscopic endonasal approach for a suprasellar craniopharyngioma. J Neurol Surg B Skull Base 2018; 79 (Suppl. 03) S241-S242
• 7 Dhandapani S, Singh H, Negm HM. et al. Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas. J Neurosurg 2017; 126 (02) 418-430
• 8 Tang B, Xiao L, Xie S. et al. Extended endoscopic endonasal approach for recurrent or residual symptomatic craniopharyngiomas. Clin Neurol Neurosurg 2018; 168: 38-45
• 9 Kalinin PL, Fomichev DV, Kutin MA. et al. Endoscopic endonasal anterior extended transsphenoidal approach in craniopharyngioma surgery. Vopr Neirokhir 2013; 77 (03) 13-20 , discussion 20
• 10 Madsen PJ, Buch VP, Douglas JE. et al. Endoscopic endonasal resection versus open surgery for pediatric craniopharyngioma: comparison of outcomes and complications. J Neurosurg Pediatr 2019; 24 (03) 1-10
• 11 Kim SK, Kim YH, Park CK, Kim DG, Jung HW. Extended endoscopic endonasal approach for recurrent or residual adult craniopharyngiomas. Acta Neurochir (Wien) 2014; 156 (10) 1917-1922
• 12 Kitano M, Taneda M. Extended transsphenoidal surgery for suprasellar craniopharyngiomas: infrachiasmatic radical resection combined with or without a suprachiasmatic trans-lamina terminalis approach. Surg Neurol 2009; 71 (03) 290-298 , discussion 298
• 13 Cavallo LM, Frank G, Cappabianca P. et al. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. J Neurosurg 2014; 121 (01) 100-113
• 14 Wannemuehler TJ, Rubel KE, Hendricks BK. et al. Outcomes in transcranial microsurgery versus extended endoscopic endonasal approach for primary resection of adult craniopharyngiomas. Neurosurg Focus 2016; 41 (06) E6
• 15 Algattas H, Setty P, Goldschmidt E. et al. Endoscopic endonasal approach for craniopharyngiomas with intraventricular extension: case series, long-term outcomes, and review. World Neurosurg 2020; 144: e447-e459
• 16 Behzadi F, Ruiz GM, Tran DH, Schaible PA, Allen MB, Germanwala AV. Evaluation of retrospective patient preference on extent of resection of nonfunctioning pituitary adenomas. World Neurosurg 2024; 182: e98-e106
• 17 Na MK, Jang B, Choi KS. et al. Craniopharyngioma resection by endoscopic endonasal approach versus transcranial approach: a systematic review and meta-analysis of comparative studies. Front Oncol 2022; 12: 1058329
• 18 Juratli TA, Jones PS, Wang N. et al. Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations. Cancer 2019; 125 (17) 2910-2914
• 19 Brastianos PK, Shankar GM, Gill CM. et al. Dramatic response of BRAF V600E mutant papillary craniopharyngioma to targeted therapy. J Natl Cancer Inst 2015; 108 (02) djv310
• 20 Roque A, Odia Y. BRAF-V600E mutant papillary craniopharyngioma dramatically responds to combination BRAF and MEK inhibitors. CNS Oncol 2017; 6 (02) 95-99
• 21 Müller HL, Merchant TE, Warmuth-Metz M, Martinez-Barbera JP, Puget S. Craniopharyngioma. Nat Rev Dis Primers 2019; 5 (01) 75
• 22 Brastianos PK, Twohy E, Geyer S. et al. BRAF-MEK inhibition in newly diagnosed papillary craniopharyngiomas. N Engl J Med 2023; 389 (02) 118-126
• 23 Habrand JL, Ganry O, Couanet D. et al. The role of radiation therapy in the management of craniopharyngioma: a 25-year experience and review of the literature. Int J Radiat Oncol Biol Phys 1999; 44 (02) 255-263
• 24 Schoenfeld A, Pekmezci M, Barnes MJ. et al. The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. J Neurooncol 2012; 108 (01) 133-139
• 25 Chiou SM, Lunsford LD, Niranjan A, Kondziolka D, Flickinger JC. Stereotactic radiosurgery of residual or recurrent craniopharyngioma, after surgery, with or without radiation therapy. Neuro-oncol 2001; 3 (03) 159-166