Article
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
Search Medline for
Authors
-
J. Flitsch
- Bereich Hypophysenchirurgie, Neurochirurgische Klinik, Universitätskrankenhaus Hamburg-Eppendorf
-
D. K. Lüdecke
- Bereich Hypophysenchirurgie, Neurochirurgische Klinik, Universitätskrankenhaus Hamburg-Eppendorf
| Published: | May 4, 2005 |
|---|
Outline
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.
