Outcomes Following Purely Endoscopic, Expanded Endonasal Resection of Suprasellar Craniopharyngiomas

Introduction: Endoscopic endonasal techniques are the result of a century of surgical and technological evolution. This evolution is reflected in the treatment of craniopharyngiomas. As with any new surgical techniques, outcomes using expanded endoscopic techniques must be carefully evaluated and compared with proven, traditional approaches. Methods: A retrospective review of craniopharyngiomas resected via a purely endoscopic, expanded endonasal approach (EEA) was conducted. Outcomes include endocrine, ophthalmologic, degree of resection, recurrence, and complications. Results: Fifteen patients underwent endoscopic EEA from June 1999 to August 2005. Five had recurrent tumors. Thirteen patients presented with vision loss. Five had resolution, 7 improvement (1 patient with a recurrent tumor initially had a transient decrement) and 1 stabilization of their vision. None had worsened vision at follow-up. There was one new case of panhypopituitarism (4 pre-existing). Six patients developed postoperative DI (diabetes insipidus): 4 transient, 2 permanent. Ten of 15 (67%) underwent complete resection of their tumor. Two had purely cystic residual and the other 3 had planned subtotal debulkings (age > 65). There have been 2 recurrences and regrowth of residual requiring treatment on 2 others. CSF leak rate following endoscopic EEA was 65%. All were successfully treated without further sequelae. There was one stroke secondary to intraoperative arterial injury. There were no hemorrhagic complications. Conclusions: Endoscopic, expanded endonasal resections of craniopharyngiomas have good outcomes in this early series with respect to endocrine, ophthalmologic, degree of resection, and neurological outcome. Endoscopic skull base reconstructions remain a work in progress, with unacceptably high CSF leak rates postoperatively.