Introduction: Craniopharyngiomas have traditionally been resected via transcranial approaches, but endoscopic endonasal transsphenoidal (EETS) approaches have gained popularity in recent years. Direct comparison between these two approaches to assess extent of resection, complications and progression-free survival have not been performed at a single institution.
Methods: Patients that underwent resection for craniopharyngioma at our institution from 2000-2013 were identified from a surgical database and retrospectively reviewed. Surgical cases were grouped by approach into EETS or Craniotomy groups. Pre and postoperative tumor volume was calculated based on MRI for each case. The groups were compared for extent of resection (EOR), complications, recurrence rate, and progression free survival (PFS).
Results: Nineteen cases of EETS and 34 cases of craniotomy were identified. Patient demographics, presenting symptoms, and tumor characteristics were similar between the two cohorts, except an increased proportion of patients undergoing reoperations in the EETS group (42.1% vs 17.6%, p = 0.05). EOR was similar between the two groups (90.7% vs. 85.6%, p = 0.77). Postoperative rates of panhypopituitarism/diabetes inspidus were similar in both groups(91.2% vs. 73.7%, p = 0.12). There was a greater rate of cranial nerve injury in the Craniotomy group(23.5% vs. 0%, p = 0.003). Postoperative CSF leak rate was higher in the EETS group (26.3% vs. 0%, p = 0.004). The PFS was similar between the two groups (log-rank p = 0.99).
Conclusions: Surgical outcomes, including EOR, hormonal complications, and PFS were similar for craniopharyngiomas resected via craniotomy or endoscopic approaches, whereas a significantly increased rate of cranial nerve injury occurred in the craniotomy cohort. EETS is a viable alternative to craniotomy for resection of craniopharyngiomas, and has a lower rate of major neurovascular complications. As such, EETS approaches appear to be the preferred method for treatment of these tumors.
Patient Care: This research will enable surgeons to compare surgical outcomes and complication rates between endoscopic endonasal and open transcranial resections of suprasellar tumors. This will allow the surgeon to better assess the use of endoscopic endonasal techniques as an alternative to open transcranial surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the surgical advantages and limitations of endoscopic endonasal approaches to suprasellar lesions. 2)Compare surgical outcomes including extent of resection and progression-free survival between open and endoscopic endonasal approaches for suprasellar tumors. 3)Contrast the differences in complications between open and endoscopic endonasal approaches for suprasellar lesions.