Surgical experiences of endoscopic endonasal approach for resection of craniopharyngiomas

Objective To present our surgical experiences with management of craniopharyngiomas (CPs) by endoscopic endonasal approach. Methods A retrospective review was conducted on clinical data of 90 patients who were treated for CPs by endoscopic endonasal approach from January 2012 to December 2016 at the Department of Neurosurgery, the first Affiliated Hospital of Nanchang University. All patients were analyzed in terms of treatment effect, complications, and follow-up results. Results Total removal of the tumors were completed in 76 cases (84.5%), subtotal removal in 12 cases (13.3%), and partial resection in 2 cases (2.2%). The pituitary stalks were identified in 76 cases during surgery and severed in 46 cases (60.5%). Postoperative visual acuity was improved in 40 cases, 18 cases remained at the preoperative level, and symptomatic worsening occurred in 1 case. New worsening of the anterior pituitary function was reported in 32 cases (35.6%), all those cases with preoperative panhypopituitarism were unchanged. New diabetes insipidus occurred in 56 cases, and transient diabetes insipidus after operation occurred in 30 patients, and long-term diabetes insipidus occurred in 26 cases. Postoperative cerebrospinal fluid (CSF) leak was reported in 6 cases accompanied with intracranial infection. All those cases were repaired under endoscope again and success was achieved in 5 cases. Perioperative mortality rate was 4.4%. A total of 77 patients were followed up for 5-50 months with an average of 23.1±13.3 months, and 65 patients (84.4%) returned to normal life. Obesity developed in 12 patients. There were 2 recurrent cases and no deaths during follow-up. Conclusions Binastril, bimanual, extended endonasal approach serves as the foundation of endoscopic craniopharyngioma resection. Under endoscopy, anatomical relationship of the tumor to the stalk, hypothalamus, perforating vessels could be confirmed precisely. The same principles in tumor resection are followed as in microscopic surgery, which is the basis of high-quality excision of craniopharyngiomas purely under endoscope. Good reconstruction of skull base is an important technique to prevent postoperative CSF leakage. Key words: Craniopharyngioma; Neuroendoscopy; Endonasal transsphenoidal approach; Surgical experience