Endonasal Transsphenoidal Surgery of Craniopharyngiomas: A Case Series

Objective: This article aims to present the results of transnasal transsphenoidal surgery of craniopharyngiomas.

Methods: A retrospective review including surgical technique, extent of resection, complications, and outcomes was performed. All patients were operated between 2007 and 2014 in the department of neurosurgery of Kazan Interregional Clinical Diagnostic Center.

Results: A total of 15 patients with craniopharyngiomas were operated. Transseptal transsphenoidal microsurgical approach with X-ray C-arm control was performed in 3 (20%) cases, and endonasal endoscopic approach (EEA) with frameless image guidance was applied at the 12 (80%) patients respectively. In seven cases, an anterior expanded approach was performed.

There were 5 males and 10 females. Patient's age was between 16 and 66 years, with a mean age of 42.4 years. Three patients (20%) required a repeat surgery because of residual tumor progression in the period of 6 to 57 months postoperatively.

Gross total resection was achieved in eight patients (53.5%), near-total in four (26.5%), subtotal in three (20%) patients. In three patients after a repeat surgery, a gross total resection was achieved in one case and subtotal in the rest two cases. All the patients with gross total resection have no signs of tumor recurrence at follow-up. The mean period of follow-up is 34 months. Overall, 13 patients has a visual disturbances, 10 (77%) of them improved and 3 (23%) remained unchanged postoperatively. No worsening of visual function was marked. A postoperative cerebrospinal fluid leak occurred in seven (47%) patients and was a reason of meningitis in two (13.3%) of them (one aseptic and one bacterial), both were cured. Six patients with cerebrospinal fluid leak underwent a surgical reconstruction of CSF fistula (one patient twice), one case of CSF leak resolved on lumbar drain. Four (27%) patients developed a diabetes insipidus in one it was transient, four (27%) showed a panhypopituitarism, and one (7%) patient had a cerebral salt-wasting syndrome postoperatively. One patient had an acromegaly and after subtotal tumor removal receiving octreotide for growth hormone relief. No patients developed a new neurological deficit with zero mortality rates.

Conclusion: Transnasal transsphenoidal approach for craniopharyngiomas is effective and safe. Endonasal endoscopic approaches combined with anterior expanded approaches makes tumor resection more radical especially in cases with suprasellar extension because of best illumination and wide exposure of skull base structures.