Endoscopic Endonasal Surgery For Cranioph Aryngiomas

Objective:To report our experience of the management of 60 craniopharyngioma patients with endoscopic endonasal surgery(EES)and evaluate the feasibility and safety of EES for craniopharyngiomas.Method: The clinical data of 60 craniopharyngioma patients who underwent EES between November 2014 and December 2017 were analysed retrospectively.All patients had vascularized nasoseptal flaps,and the most recent 4 patients had “in situ bone flaps” for better skull base reconstruction.Visual improvements,tumour resection extents,recurrence rates,endocrine functional changes and surgical complications were evaluated.Results: The resection rates were as follows: gross-total,68.3%(41patients);near-total(>95% of tumour removed),15%(9 patients);subtotal(≥80% of tumour removed),10%(6 patients),and partial(PR<80% of tumour removed)6.7%(4 patients).Fifty-two patients presented with visual impairment;of these,46(88.5%)improved or returned to normal after surgery.Regarding the 32 patients with hypopituitarism before surgery,pituitary function was unchanged in 15(46.8%),improved or normalized in4(12.5%)and deteriorated in 13(40.6%).Eleven patients(18.3%)suffered from diabetes insipidus before treatment,and 27 more patients had this condition after surgery.Twenty-two patients had hyposmia postoperatively,and 17 patients experienced significant weight gain.Four patients had recent memory loss,and two of them had a temporary recent mental disorder.Three(5%)patients had CSF leakage after surgery.Three patients(5%)contracted meningitis and were cured with antibiotic treatment.One patient showed recurrence by MRI re-examination,at the mean follow-up time of 22 months(range,8-45 months;SD,11 months).Conclusion: EES can provide surgeons with excellent exposure and can achieve a high extent of removal of most craniopharyngiomas,even those with intraventricular extensions,in our view,vascularized pedicled septal flaps and in situ bony flaps were used in skull base reconstruction.