Endocrine Abstracts

Introduction: The management of craniopharyngioma (CR) remains a challenge. The introduction of endoscopic technique in the surgical approach to the sellar/suprasellar region would have profound implications for treatment. The aim of the study was to analyze results, advantages and limits of endoscopic endonasal approach (EEA).

Design/methods: From 1998 to 2012, 95 patients underwent surgery for CR. Trancranial approach was chosen for 33 patients (35%) on the basis of shape, size, and location. The remaining 62 (52% sellar and suprasellar, 45% purely suprasellar, 3% purely intrasellar; male to female ratio: 0.73; median age: 46 years, range, 3–83 years; 26% aged 18 years or younger) were operated by EEA, for a total of 71 surgical procedures, including nine recurrences during the follow-up period (mean: 59 months, range, 3–98).

Results: At presentation, visual impairment was detected in 77%, hypopituitarism in 54%, isolated diabetes insipidus (DI) in 3%, panhypopituitarism coupled with DI in 24%. Endocrine function became further worse postoperatively, as expected (novel cases of DI and hypopituitarism occurred in 12.6 and 15.4%, respectively); conversely, after EEA visual function returned to normal in 35%, improved in 47%, and remained unchanged in 18%. Gross tumor removal was obtained in 80%. Morbidity consisted in post-operative CSF leak (18%) and chronic subdural haematoma (1.5%); one acute post-operative hydrocephalus (1.5%) was fatal. Weight gain occurred in 6%. Recurrence rate was 14.5%. Quality of life was preserved in 85% of cases, a moderate worsening (social reintegration at a lower level) occurred in 10% and a heavy worsening (semi- or totally dependent) in 5%.

Conclusions: EEA was a reliable approach in the majority of patients (65%) referred to us. The technique, safe and well tolerated, provides a direct approach along the way of the tumour growth and allows the surgeon to remove the lesion, avoiding brain retraction and vascular-nervous structures manipulation.