Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas

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• 作者：Dmitry Fomichev ; ^{dfomichev@list.ru" class="auth_mail" title="E-mail the corresponding author} ; Pavel Kalinin ; Maxim Kutin ; Oleg Sharipov
• 关键词：Anterior extended transsphenoidal endoscopic endonasal approach ; Craniopharyngiomas ; Skull-base surgery ; Transnasal approach
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：181-187
• 全文大小：2261 K

文摘

The endoscopic extended transsphenoidal approach for suprasellar craniopharyngiomas may be a really alternative to the transcranial approach in many cases. The authors present their experience with this technique in 136 patients with craniopharyngiomas.

Methods

From the past 7 years 204 patients with different purely supradiaphragmatic tumors underwent removal by extended endoscopic transsphenoidal transtuberculum transplanum approach. Most of the patients (136) had craniopharyngiomas (suprasellar, intra-extraventricular). The patients were analyzed according to age, sex, tumor size, growth and tumor structure, and clinical symptoms. Twenty-five patients had undergone a previous surgery. The mean follow-up was 42 months (range, 4–120 months). The operation is always performed with the bilateral endoscopic endonasal anterior extended transsphenoidal approach.

Results

A gross-total removal was completed in 72%. Improvement of vision or absence of visual deterioration after operation was observed in 89% of patients; 11% had worsening vision after surgery. Endocrine dysfunction did not improve after surgery, new hypotalamopituitary dysfunction (anterior pituitary dysfunction or diabetes insipidus) or worsening of it was observed in 42.6%. Other main complications included transient new mental disorder in 11%, temporary neurological postoperative deficits in 3.7%, bacterial meningitis in 16%, cerebrospinal fluid leaks in 8.8%. The recurrence rate was 20% and the lethality was 5.8%.

Conclusions

Resection of suprasellar craniopharyngiomas using the extended endoscopic approach is a more effective and less traumatic technology, able to provide resection of the tumor along with high quality of life after surgery, and relatively rare postoperative complications and mortality.