Role of Skull Base Surgery for Craniopharyngiomas

Introduction: Our policy of treatment of craniopharyngiomas is radical tumor resection even in cases with recurrent lesions. We focus on the efficiency of skull base approaches for the radical resection of Craniopharyngiomas.

Methods: 63 consecutive patients (mean age, 39.9 year; range, 4–74 year) with craniopharyngioma, including 22 patients with recurrence, underwent 91 times of surgery at Osaka City University Hospital for the past 18 years. Best surgical corridor was selected among several skull base approaches according to the individual variation including the tumor size, location, consistency and its extension. Surgical approaches included transpetrosal approach in 31 times, orbitozygomatic approach in 33, transsphenoidal approach in 10 and subfrontal interhemispheric/basal approach in 13 and others in 2. Length of the follow-up ranged from 5 to 216 months (mean, 112).

Results: Gross total removal (no residual enhancement) was accomplished in 40 patients (64%), near total resection (thin rim or spot enhancement) in 21 (33%) and subtotal in 2 (3%). The reasons for incomplete removal were mainly involvement of vascular structures. The part of tumor adhered to the inferior surface of chiasma was completely resected in all patients. Overall operative morbidity except for endocrinological function was 10% (6 patients), including 3 patients with cognitive dysfunction and 3 patients with visual deterioration. Ophthalmological function was significantly improved after operation. Using Kaplan-Meier analysis, cumulative recurrent-free survival rate was 85.2% at 5 year and 78.1% at 10 years.

Conclusion: Our satisfactory results suggest that use of the skull base approaches can render the improvement of surgical outcomes in properly selected patients with craniopharyngioma, even in cases of recurrence.