yOutcomes Following Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population.

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yOutcomes Following Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population.

World Neurosurg. 2017 Aug 21;:

Authors: Patel VS, Thamboo A, Quon J, Nayak JV, Hwang PH, Edwards M, Patel ZM

Abstract
BACKGROUND: Craniopharyngiomas have traditionally been treated via open, transcranial approaches. More recently, endoscopic, transsphenoidal approaches have been increasingly utilized; however very few case-series exist in the pediatric population.
METHODS: A retrospective review of patients (<18 years) undergoing endoscopic transsphenoidal resection of craniopharyngiomas between 1995 and 2016 was performed. Preoperative data included presenting symptoms, tumor size, location, and components. Postoperative outcomes included symptom resolution, visual outcomes, endocrine outcomes, disease recurrence, and major complications.
RESULTS: 16 pediatric patients with mean age of 11.0 (range = 5 - 15) were included. The median follow-up time was 56.2 months. Mean maximal tumor diameter was 3.98 cm. The majority of the tumors had suprasellar (93.8%) and intrasellar (68.8%) components. The gross-total resection rate was 93.8%. The most common presenting symptoms were vision changes (81.3%) and increased intracranial pressure (56.3%). The majority of patients (66.7%) had their presenting symptoms resolved by their first postoperative visit. Vision improved or remained normal in 69.2% of patients. Postoperatively, new incidence of panhypopituitarism or diabetes insipidus (DI) developed in 63.6% and 46.7% of patients respectively. New hypothalamic obesity developed in 28.6% of patients. The postoperative CSF leak rate was 18.8%. One patient died from intraventricular hemorrhage postoperatively. The major complication rate was 12.5%. Disease recurrence occurred in one patient with GTR (6.3%).
CONCLUSION: Endoscopic transsphenoidal resection for craniopharyngiomas can achieve high rates of total-resection with low rates of disease recurrence in larger tumor sizes than previously described. However, hypothalamic-pituitary dysfunction and CSF leak still remain significant postoperative morbidities.

PMID: 28838874 [PubMed - as supplied by publisher]

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