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  • A New Zealand Experience of Endoscopic Endonasal Management of Craniopharyngiomata

    Final Number:
    1492

    Authors:
    Andrew J Gauden MBBS (Hons); Calum Pears MBBS; Agadha Wickremesekera MD, FRACS; Andrew John Parker MBBS; Simon Robinson FRACS; Campbell John Baguley FRACS; Stephen Santoreneos; Peter-John Wormald MD; FRACS, FCS(SA); FRCS (Ed); MBChB

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Endoscopic endonasal transphenoidal approaches to craniopharyngiomata has become increasingly popular over the last 15 years. In select patients this procedure that can be performed with ease of access and with minimal morbidity. Currently, only few published reports of this approach are in the literature to date and generally these are restricted to large high volume endoscopic centres. We present the results of our retrospective series of craniopharyngiomata resected by an endoscopic, endonasal approach.

    Methods: From 2011 to 2015, all patients undergoing pure endoscopic endonasal transsphenoidal resection for a craniopharyngioma at our institution were included. The medical records, histopathology, intraoperative findings and imaging were retrospectively assessed.

    Results: From 2011 to 2015 7 patients were assessed with 4 male and 3 female patients. The mean age was 37.6 years (range 14-68 years). Of this patient series a gross total resection of the tumour was achieved in all 7 patients (100%). In the immediate postoperative phase 6 of the 7 patients developed diabetes insipidus (85%). Three of these patients still had confirmed diabetes insipidus at the first follow-up period (43%). Five (71%) of the 7 patients had a diagnosis of panhypopituitarism with one resolving over the duration of follow-up. All patients presented with a degree of visual deficit. 3 patients (43%) had noted an improvement to their presenting visual symptoms. No patients developed a cerebrospinal fluid leak postoperatively.

    Conclusions: For selected tumours the endoscopic endonasal transsphenoidal approach for excision of craniopharyngioma can achieve adequate decompression of critical structures and attain high rates of gross total resection and disease control. This endoscopic endonasal approach offers superior visualisation and negates the need for brain retraction in patients with predominantly midline tumours. Our patient series demonstrates the feasibility of this approach with the longest follow-up period published to date.

    Patient Care: Our research demonstrates the feasibility and safety of the endoscopic endonasal approach to craniopharyngiomata. We provide further evidence to assist in better patient selection for this procedure.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the indications and utility of the endonasal endoscopic approach to craniopharyngiomata 2) To describe the New Zealand Wellington experience of craniopharyngiomata 3) To understand that excellent outcomes with high degrees of excision can be achieved in non high volume endoscopic skull-base centres

    References: 1. Zacharia, B.E., et al., Incidence, treatment and survival of patients with craniopharyngioma in the surveillance, epidemiology and end results program. Neuro Oncol, 2012. 14(8): p. 1070-8. 2. Weiner, H.L., et al., Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery, 1994. 35(6): p. 1001-10; discussion 1010-1. 3. Tuniz, F., et al., Multisession cyberknife stereotactic radiosurgery of large, benign cranial base tumors: preliminary study. Neurosurgery, 2009. 65(5): p. 898-907; discussion 907. 4. Bunin, G.R., et al., The descriptive epidemiology of craniopharyngioma. J Neurosurg, 1998. 89(4): p. 547-51. 5. Chakrabarti, I., et al., Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg, 2005. 102(4): p. 650-7. 6. Hoffman, H.J., Surgical management of craniopharyngioma. Pediatr Neurosurg, 1994. 21 Suppl 1: p. 44-9. 7. Zacharia, B.E., et al., Endoscopic Endonasal Management of Craniopharyngioma. Otolaryngol Clin North Am, 2016. 49(1): p. 201-12. 8. Stripp, D.C.H., et al., Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. International Journal of Radiation Oncology*Biology*Physics, 2004. 58(3): p. 714-720. 9. Chiou, S.M., et al., Stereotactic radiosurgery of residual or recurrent craniopharyngioma, after surgery, with or without radiation therapy. Neuro Oncol, 2001. 3(3): p. 159-66. 10. Jeon, C., et al., The therapeutic efficacy of fractionated radiotherapy and gamma-knife radiosurgery for craniopharyngiomas. J Clin Neurosci, 2011. 18(12): p. 1621-5. 11. Leng, L.Z., et al., Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery, 2012. 70(1): p. 110-23; discussion 123-4. 12. Jane, J.A., Jr., et al., Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas. Neurosurg Focus, 2010. 28(4): p. E9. 13. Fahlbusch, R., et al., Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg, 1999. 90(2): p. 237-50. 14. Laws, E.R., Jr., Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg, 1994. 21 Suppl 1: p. 57-63. 15. Maira, G., et al., Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery, 1995. 36(4): p. 715-24. 16. Baskin, D.S. and C.B. Wilson, Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg, 1986. 65(1): p. 22-7. 17. De Vile, C.J., et al., Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J Neurosurg, 1996. 85(1): p. 73-81. 18. Hoffman, H.J., et al., Aggressive surgical management of craniopharyngiomas in children. J Neurosurg, 1992. 76(1): p. 47-52. 19. Yasargil, M.G., et al., Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg, 1990. 73(1): p. 3-11. 20. Campbell, P.G., et al., Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas. Neurosurgical Focus, 2010. 28(4): p. E8. 21. Cavallo, L.M., et al., Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. Journal of Neurosurgery, 2009. 111(3): p. 578-89. 22. de Divitiis, E., et al., Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery, 2007. 61(5 Suppl 2): p. 219-27; discussion 228. 23. Frank, G., et al., The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery, 2006. 59(1 Suppl 1): p. ONS75-83; discussion ONS75-83. 24. Gardner, P.A., et al., Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. Journal of Neurosurgery, 2008. 109(1): p. 6-16. 25. Dusick, J.R., et al., The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg, 2005. 102(5): p. 832-41. 26. Honegger, J., et al., Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol, 1992. 37(3): p. 189-96. 27. Kitano, M. and M. Taneda, Extended transsphenoidal surgery for suprasellar craniopharyngiomas: infrachiasmatic radical resection combined with or without a suprachiasmatic trans-lamina terminalis approach. Surg Neurol, 2009. 71(3): p. 290-8, discussion 298. 28. Kim, S.K., et al., Extended endoscopic endonasal approach for recurrent or residual adult craniopharyngiomas. Acta Neurochirurgica, 2014. 156(10): p. 1917-22. 29. Leng, L.Z., et al., "Gasket-seal" watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery, 2008. 62(5 Suppl 2): p. ONSE342-3; discussion ONSE343. 30. Patel, K.S., et al., Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas. Journal of Neurosurgery, 2015. 123(3): p. 571-80.

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