What Have Been Changing in Craniopharyngiomas Surgery

Introduction: In the past 15 years, the endoscopic endonasal technique has been expanding its role in the surgery of craniopharyngiomas (CRph), allowing to treat not only endo- and suprasellar CRph, but also purely suprasellar tumors. We revised our surgical experience to investigate what has been changing in the choice of the surgical treatment, reporting out results with the innovative surgical approach. Materials and Methods: We retrospectively revised all midline craniopharyngiomas, treated between 1998 and 2012 through a transcranial and endoscopic endonasal approach at our center. All pre- and postoperative clinical reports and neuroimaging studies have been revised. Results: A total of 95 patients were operated through 126 surgical procedures. Of these patients, 26 were pediatrics. Overall, 65 patients had been operated through an EEA and 37 through a TA (seven cases had undergone to both surgeries). In the considered time, the endoscopic endonasal approach has progressively been becoming the approach of choice for all midline craniopharyngiomas, with the exception of the intraventricular tumors. The endoscopic endonasal approach has allowed to obtain a radical tumor removal in 84% of cases. Visual symptoms were normalized at follow-up in 34%, improved in 43%, and worsened in 3% (two cases). At endocrinological follow-up, 81% of patients presented panhypopituitarism, 17% partial hypopituitarism, and DI was present in 86% of cases. Quality of life is normal and was preserved in 86%. The recurrence rate was 11%. Complications consisted in 11 CSF leaks (17%), 2 (3%) hydrocephalus (one resulted fatal), and 1 chronic subdural hematoma (1.5%). Conclusion: During the past 15 years, endoscopic endonasal approach had proved an increasing role, becoming the treatment of choice for every CRphs, except the intraventricular tumors. This was because of the good visual outcome, the reduced neurological sequelae and the greater preservation of quality of life, which we observed with this approach. The endonasal route favors the dissection of the tumor though an arachnoid plane, allowing the preservation of nerves and vessels. Unfortunately, the EEA is hampered by a high complication rate, mainly represented by CSF leaks.