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.
