Surgical Outcomes in Patients with Adult-Onset Craniopharyngioma: Craniotomy Versus Endoscopic Endonasal Transsphenoidal Surgery

Objective: This study aims to compare surgical outcomes of craniotomy and endoscopic endonasal transsphenoidal surgery (ETSS) in patients with adult-onset craniopharyngioma.

Introduction: Craniopharyngiomas are benign neuroepithelial tumors arising from embryonal remnants of Rathke’s pouch. These tumors can cause significant endocrinopathies and visual deficits and are challenging to manage due to their proximity to critical neurovascular structures. Both craniotomy and ETSS approaches have been utilized as treatment modalities for craniopharyngioma; however, there is no consensus on whether one approach is superior to the other.[1] [2]

Methods: A retrospective review of patients who underwent resection of adult-onset craniopharyngioma at a single institution between 1989 and 2023 was performed. Demographic, radiographic, and clinical data were collected. Cases were categorized by surgical approach: craniotomy and ETSS. Immediate postoperative and long-term outcomes were compared between these cohorts.

Results: Among 105 patients with adult-onset craniopharyngioma, 128 surgeries were performed: 43 ETSS and 85 craniotomies. Patient demographic data, presenting symptoms, and tumor characteristics were similar between these two groups. Logistic regression analysis revealed that the ETSS approach had an increased likelihood of achieving gross total resection (OR = 3.471, 95% CI = 1.514–7.465, p = 0.001) and decreased likelihood of postoperative tumor recurrence or progression (OR = 0.315, 95% CI = 0.125–0.792, p = 0.011) compared to craniotomy. Postoperatively, patients undergoing ETSS were less likely to experience deep venous thrombosis (DVT)/pulmonary embolism (PE) (OR = 0.274, 95% CI = 0.076–0.989, p = 0.037) and postoperative infections, including urinary tracts infections (UTIs), pneumonia, and bacteremia (OR = 0.602, 95% CI = 0.514–0.704, p = 0.008), but more likely to develop postoperative cerebrospinal fluid (CSF) leakage (OR = 15.484, 95% CI = 3.276–73.194, p ≤ 0.001). The difference in the rates of postoperative visual improvement and endocrinopathies between these two groups was not statistically significant ([Tables 1]–[3]).

Conclusion: This retrospective review of 105 patients who underwent surgical resection for adult-onset craniopharyngioma revealed that ETSS had an increased likelihood of gross total resection and a decreased likelihood of postoperative tumor recurrence. Patients undergoing ETSS were at a lower risk of developing postoperative infections and DVT/PE but were more likely to develop postoperative CSF leakage.

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No conflict of interest has been declared by the author(s).

• References

• 1 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2012; 77 (02) 329-341 PubMed
• 2 Nie C, Ye Y, Wu J, Zhao H, Jiang X, Wang H. Clinical outcomes of transcranial and endoscopic endonasal surgery for craniopharyngiomas: a single-institution experience. Front Oncol 2022; 12: 755342 PubMed

Publication History

Article published online:
05 February 2024