gms | German Medical Science

Objective: Craniopharyngiomas are still surgically challenging because of their location in the complex sella area, adherence to vulnerable neurovascular structures, and high recurrence rate. Presently, surgical resection using a transcranial route is the recommended first line treatment. With the introduction of endoscopic transsphenoidal techniques in the last few years, it has been advocated that Craniopharyngeomas may be easier and safer removed using the transsphenoidal route. Objective of this study is to compare our results using a transcranial versus a transsphenoidal route for resection of Craniopharyngeomas.

Method: We retrospectively analyzed 23 operations performed in 17 patients suffering from Craniopharyngiomas. 12 tumors were operated using a transcranial minimally invasive approach (7 subfrontal, 5 transventricular), 11 endoscopic transsphenoidal approach. Patient's age ranged from 7 to 71 years. Four patients had recurrent tumors in the transcranial group and 2 in the transsphenoidal group. Outcome, resection grade, and complications were evaluated.

Results: Gross total resection could be achieved in 5 out of 12 cases in the transcranial group and in 10 out of 11 in the transsphenoidal group. Approach related complications were infection requiring surgical revision in 1 patient in the transcranial group and CSF leaks in 3 cases in the transsphenoidal route, requiring surgical revision in 2 cases. Diabetes insipidus, hypothalamic dysfunction, and visual deficits were less frequent in the transsphenoidal group.

Conclusions: Our retrospective data show, that endoscopic transsphenoidal resection provides a higher rate of gross total resection (10/11 tumors) and a better outcome for Craniopharyngeomas compared with the transcranial route, even when using minimally invasive technique. However, CSF leaks are more prominent (3/11) using the transsphenoidal route.