Outcome and mid-term prognosis after maximum and radical removal of craniopharyngiomas with the priority to the extended transsphenoidal approach--a single center experience

Abstract

Objective: The transsphenoidal approach has been increasingly used for the surgical treatment of craniopharyngiomas with/without sellar enlargement. However, the optimum indications for the extended transsphenoidal approach with opening of the posterior ethmoidal sinus in addition to opening of the sellar floor are still controversial.

Methods: Forty-two patients with craniopharyngiomas treated by the extended transsphenoidal approach were retrospectively studied from a series of 993 cases of pituitary surgeries between April 2004 and September 2013. Removal rate, visual function, endocrinological changes, and mid-term prognosis were investigated.

Results: Gross total removal was achieved in 31 of 42 patients (73.8%) overall, in 24 of 27 patients (88.9%) undergoing initial treatment, and in 7 of 15 patients (46.7%) undergoing re-treatment after previous transcranial tumor removal and/or radiation therapy. The major cause of abandonment of surgery in the re-treatment group was tight adhesion and/or encasement of the perforating arteries. The rate of total removal showed a significant difference between initial treatment and re-treatment groups (logrank test, p<0.001). Only one patient suffered tumor recurrence after total removal, but the others remained disease-free during the follow-up period. Postoperative visual acuity was improved in 20 of 40 patients evaluated, remained steady in 20, and deteriorated in none, indicating good ophthalmological outcomes in all 40 patients. The pituitary stalk was intentionally sectioned in 18 of 42 patients, and 9 of the 18 patients could discontinue usage of antidiuretic hormone in the follow-up period. All patients were discharged without neurological deficits, except for two patients with preoperative dysfunction of the mammillary bodies, and all maintained independence in daily life with hormonal supplementation. No other complications including cerebrospinal fluid leakage were experienced in the follow-up period.

Conclusions: Maximum and radical removal through the extended transsphenoidal approach achieved high rate of total removal and good visual outcomes. However, re-treatment still presents challenges.

Keywords: Craniopharyngioma; Extended transsphenoidal approach; Mid-term prognosis; Multidisciplinary treatment; Re-treatment.