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J Neurol Surg B Skull Base
DOI: 10.1055/a-2301-3867
Original Article

Endoscopic Endonasal Approach for Residual and Recurrent Craniopharyngioma after Transcranial Approach: A Multi-institutional Experience

Ronak H. Jani 
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
,
Sudesh Raju
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Miri Kim
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
,
Paul Gardner
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Georgios A. Zenonos
2   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Carl Snyderman 
3   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Eric W. Wang
3   Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Chirag Patel
4   Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
,
Anand V. Germanwala
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
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Abstract

Objectives While the endoscopic endonasal approach (EEA) has become a well-established surgery for resection of craniopharyngiomas (CP), the utility of this procedure following subtotal resection from open transcranial approach (TCA) surgery has yet to be explored. Here we present a multi-institutional case series of patients who underwent EEA for treatment of recurrent CP originally treated by TCA, demonstrating the viability of this approach as salvage surgery.

Design Retrospective cohort.

Setting Loyola University Medical Center and University of Pittsburgh Medical Center.

Participants Patients who underwent EEA for recurrent CP following an initial TCA between 2003 and 2018.

Main Outcome Measures Gross total resection (GTR) rate, surgical complications, visual outcomes, and endocrine outcomes

Results Patients who underwent EEA for recurrent CP following a prior TCA had a GTR rate of 77%. EEA reoperation was not associated with worsening of visual outcomes as compared with the primary TCA (0% visual worsening after EEA reoperation vs. 40% after primary TCA, p = 0.055). While primary TCA resulted in worsening endocrinopathies in 100% of patients (including seven patients with permanent diabetes insipidus), subsequent EEA for re-resection of CP resulted in stable (30.8%) or improved (69.2%) endocrine function in all patients (p < 0.001).

Conclusions EEA achieves reasonable GTR rates and is an effective, safe surgical option for recurrent CP postinitial TCA. This approach demonstrated stable or improved visual and endocrinologic outcomes in all patients within our two-institution series. Thus, EEA should be considered as an efficacious form of retreatment in cases of progressive and recurrent CP.

Keywords

craniopharyngioma - endoscopic endonasal approach - craniotomy - recurrence

Previous Presentation

Portions of the abstract of this study were presented at the 2023 North American Skull Base Society meeting (Tampa, Florida, United States, February 17, 2023) and published in the society's supplemental journal containing abstracts from presentations at the meeting.




Publication History

Received: 22 February 2024

Accepted: 04 April 2024

Accepted Manuscript online:
08 April 2024

Article published online:
03 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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