Transsphenoidal Surgery in Craniopharyngioma Patients: Outcomes Stratified by Tumor Subtype

Introduction: Recent literature has suggested that adamantinomatous and papillary craniopharyngiomas are mutually exclusive and genetically distinct subtypes of craniopharyngiomas. While some recent studies have examined the distinctive symptoms, clinical course, and genomic landscapes of these tumor subtypes, there is limited literature on surgical outcomes of adult craniopharyngioma patients after transsphenoidal surgery stratified by tumor subtype.

Methods: We retrospectively analyzed an institutional cohort of patients who had undergone transsphenoidal surgery for craniopharyngioma between 2008 and 2019. Patients diagnosed with craniopharyngioma were categorized on the basis of tumor subtype as follows: adamantinomatous, papillary, and indeterminate craniopharyngioma. Surgical approach, clinical, and radiological characteristics at baseline, as well as intraoperative and postoperative complications were recorded and compared. Preoperative and postoperative lab values of sodium, prolactin, TSH, free thyroxine (T4), IGF-1, and ACTH were determined at baseline and postoperatively. Tumor characteristics such as size, location, and cystic nature were determined using preoperative magnetic resonance imaging (MRI) and computed tomography (CT) scans. Patients were categorized as having low or high lab values if hormone levels fell below or above normal ranges at any time preoperatively or postoperatively. A multiple logistic regression model was produced to predict the likelihood of developing any postoperative complication based on the tumor subtype, patient demographics, and preoperative tumor characteristics.

Results: A total of 36 craniopharyngioma patients were included, 20 of which were diagnosed with the adamantinomatous subtype, 5 with the papillary subtype, and 12 with an indeterminate subtype. The most common tumor subtype was adamantinomatous, and patients were aged between 18 and 85 at the time of surgery. There were no significant differences in the demographics or preoperative tumor characteristics between the three subtypes of tumor. In all three groups, the majority of tumors were cystic, ranging from 60% of papillary tumors to 75% of indeterminate tumors. Patients did not differ in preoperative comorbidities or symptoms. The most common symptom was vision loss, present in 67.6% of patients. There were no differences in preoperative or postoperative lab values. 18.9% of patients required reoperation, 21.6% experienced postoperative CSF leaks, and 21.6% of patients developed transient diabetes insipidus. The incidence of postoperative complications or ICU admissions did not differ among the three groups. Multivariate analysis showed that tumor subtype, patient demographics, tumor dimensions, and tumor location were not predictive of postoperative complication incidence.

Conclusion: In adult patients receiving transsphenoidal surgery, craniopharyngioma subtype does not appear to be associated with differing risks of postoperative complications. However, this preliminary study is limited as the current sample might be underpowered to detect a difference in outcomes ([Tables 1]–[4]; [Fig. 1]).

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Publication History

Article published online:
05 February 2024