Artikel
Endonasal versus transcranial approaches in suprasellar craniopharyngioma surgery – a single-centre outcome analysis with regard to olfaction and quality of life
Endonasaler versus transkranieller Zugang zu suprasellären Kraniopharyngeomen – eine monozentrische Studie mit Bezug auf die Riechfuntion und die Lebensqualität
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Autoren
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Sascha Marx
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Ioanna Tsavdaridou
- Universitätsmedizin Greifswald, Klinik für Poliklinik und HNO-Heilkunde, Greifswald, Deutschland
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Sebastian Paul
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Augenheilkunde, Greifswald, Deutschland
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Ehab El Refaee
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Marton Eördögh
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Stephan Nowak
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Steffen K. Fleck
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Jörg Baldauf
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
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Werner Hosemann
- Universitätsmedizin Greifswald, Klinik für Poliklinik und HNO-Heilkunde, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurochirurgie, Greifswald, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Endoscopic endonasal approaches gained popularity, but their superiority in relation to transcranial approaches is still questionable in surgery for suprasellar craniopharyngiomas. There is a lack of data with regard to functional outcome parameter like olfaction and quality of life in the long-term course after surgery.
Methods: All patients who underwent surgery for suprasellar craniopharyngiomas between 2001 and 2017 in our department were included in the study. Clinical long-term follow-up examinations, including olfactometry and quality of life questionnaires (SNOT-22 and ASBQ) were done for all patients. Comparative analysis was done for patients with endonasal versus transcranial approach and for patients who received radiotherapy and those who did not.
Results: Surgery for suprasellar craniopharyngiomas was done transcranial (A) or endonasal (B) in 13 and 14 patients, respectively. Transcranial procedures were done via fronto-lateral or frontal craniotomy and endonasal procedures were full endoscopically in all patients, respectively. The pituitary stalk was sacrificed in 8 and 3 patients of A and B, respectively. 6 patients were lost to follow-up. Mean follow-up was 136 and 67 months in A and B, respectively. 8 patients received radiotherapy during follow up due to tumor recurrence or tumor remnant.
There was no difference in the olfactometry in patients with endonasal and transcranial approaches. However, patients who received radiotherapy had a significantly reduced olfaction compared to those who did not (p=0.01). There was no difference between the groups in the SNOT-22 questionnaire, but there was a tendency of a higher ABSQ value in the endonasal group (p=0.2). The visual outcome was superior in (B) compared to (A).
Conclusion: The present study did not show a difference between endonasal and transcranial approaches to suprasellar craniopharyngiomas with regard to the olfaction status. However, patients who received radiotherapy had a reduced olfaction, regardless of the surgical approach. Long-term quality of life is slightly but not significant better in patients with endonasal approach. The major limitation is the small number of patients. However, suprasellar craniopharyngiomas are rare.
