Endonasal Endoscopy versus Transcranial Microsurgery for Large Suprasellar Craniopharyngiomas

Objective: Endonasal endoscopy (EE) is increasingly being adopted for suprasellar craniopharyngiomas with unclear comparative efficacy with transcranial microsurgery (TM). This is a prospective study of EE for large suprasellar craniopharyngiomas in comparison to TM.

Methods: Patients of suprasellar craniopharyngiomas larger than 20 mm who undergo EE were prospectively studied with comparative cases of TM in our department as controls. The extent of resection as per MRI, need for hormone supplements, and retreatment were assessed with a minimum follow-up of 6 months. Appropriate statistical analyses were performed.

Results: Of the total 39 patients, 19 underwent EE for large suprasellar craniopharyngiomas. The mean maximum tumor dimension was 39.6 mm in EE cases, compared to 43 mm in TM (p = 0.55). Over a mean follow-up of 47 months, 36 patients could be assessed fully. Gross- or near-total resection was noted among 84% (16/19) after EE, whereas 47% (8/17) after TM (p = 0.02). Retreatment was required in 26% (5/19) of patients following EE, compared to 71% (12/17) after TM (p = 0.01). Long-term diabetes insipidus requiring vasopressin analogs was noted in 42 and 53%, respectively, with no significant difference.

Conclusion: Among similar cases of large suprasellar craniopharyngiomas, endonasal endoscopy seems to have a significantly better resection and less retreatment rates but similar long-term diabetes insipidus, compared to transcranial microsurgery.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022