gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Results of transsphenoidal surgery for craniopharyngeomas: comparison of the direct anterior and the ultra-direct approach

Ergebnisse der transspenoidalen Operation bei Craniopharyngeomen: Vergleich des direkt anterioren und ultra-direkten Zugangs

Meeting Abstract

Suche in Medline nach

  • corresponding author J. Flitsch - Bereich Hypophysenchirurgie, Neurochirurgische Klinik, Universitätskrankenhaus Hamburg-Eppendorf
  • D. K. Lüdecke - Bereich Hypophysenchirurgie, Neurochirurgische Klinik, Universitätskrankenhaus Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-07.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0198.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Flitsch et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

It is well known that transsphenoidal surgery (TSS) is the least traumatic approach to intrasellar/suprasellar infradiaphragmatic lesions. We compared the results of primary TSS using the direct anterior or the ultra-direct approach.

Methods

34 patients underwent primary TSS for craniopharyngeomas (1985-96) by the direct anterior approach [Series A, 3/year], 20 patients were primarily operated via the ultra-direct approach (2000-04, 6/year) [Series B]. Complete selective tumour resection was performed whenever possible. In all other cases, heating of capsule remnants using a suction-irrigation system and micro-mirrors followed incomplete resection. The charts were reviewed for patient’s age, symptoms, tumour size, surgical results, outcome and follow-up (at least six months).

Results

Series A (34 cases): 14 patients (42%) were age 18 or younger. Headaches and/or visual symptoms were found in 16 and 18 cases. Hypogonadism affected 12 of 20 adults, growth delay was found in 9 of 14 children. Diabetes insipidus (D.i.) occurred in 8 patients. Average tumour size was 21.9 mm (10–40). A complete resection was performed in 13 cases (38%), 21 had subtotal resections. Pituitary function remained intact in 15 (44%), new insufficiencies of one axis occurred in 6 cases, of two axes twice, anterior lobe insufficiency once. In 5 of 11 cases postoperative D.i. persisted. Surgical complications included 3 CSF-leaks (2 needed surgical closure), and 2 nasal bleedings. Recurrence was found in 3 patients (8%), 2 requiring re-TSS and 1 radiotherapy. Series B (20 cases): 11 patients (55%) were age 18 or younger. Headaches and/or visual symptoms were found in 9 and 7 cases. Hypogonadism affected 9 adults, growth delay 5 children, complete anterior lobe insufficiency 4 patients, D.i. 2 patients. Average tumour diameter was 16.6 mm (12-40). Complete resection was performed in 6 cases (27%), subtotal resection in 14. Pituitary functions remained intact in 9 (45%), in 3 of 5 postoperative D.i. persisted, 2 patients showed decrease in one, 3 in two pituitary axes, 1 showed new hypopituitarism. Surgical complications included a bacterial pituitary abscess (treated by antibiotics). So far, only 1 patient needed additional transcranial surgery and radiation therapy. No hypothalamic damage was found in either series, neurological symptoms improved in all.

Conclusions

The new, ultra direct approach is equally feasible for TSS with sufficient visibility of the anatomical structures and with higher patient comfort.