Long-term Follow-up Outcome Study Of Endoscopic Endonasal Approach Treating Craniopharyngiomas

Objective:To analyze the postoperative complications of endoscopic endonasal approach(EEA)treating craniopharyngiomas,progression-free survival(PFS)and long-term follow-up outcomes.Patients and methods:A retrospective analysis of 113 cases of craniopharyngiomas treated by EEA in this medical center during 2012-2020 was carried out and the longitudinal medical records of these patients were evaluated and long-term follow-ups were conducted.Results:Of the 113 patients with craniopharyngiomas,95 cases(84.1%)tumor Gross-total resection(GTR)and 18 cases(15.9%)had non-gross total resection(NGTR).The nature of the tumor affected the total resection rate of the tumor(solid,cystic,cystic solid GTR rates were 71.4%,66.7%,88.6% respectively).Among 90 patients without preoperative diabetes insipidus(DI),66(75%)had new DI.77patients(68.1%)had deterioration of endocrine function in anterior pituitary after the operations.Of 69 patients with preoperative visual acuity and visual field injury,51(73.9%)had improved visual acuity and visual field.10 cases(8.8%)had postoperative cerebrospinal fluid(CSF)leakage and did the surgeries to repair CSF stillicidium narium,and no permanent CSF stillicidium narium was observed.Six patients(5.3%)underwent postoperative CSF examination and confirmed intracranial infection.After anti-inflammatory and lumbar cistern drainage,3 patients recovered.As of the last follow-up,six patients(5.3%)died,seven patients(6.2%)had tumor recurrence.A patient’s PFS analysis showed,there were significant differences in PFS between GTR and NGTR patients(p=0.016,<0.05).Long-term follow-up showed that there was a significant decrease in sleep changes in hypothalamic nerve function compared with that in preoperative(p=0.031,<0.05).There was no significant difference between preoperative and long-term follow-up outcomes in patients’ quality of life(QOL)(p=0.14,<0.05).Conclusion:EEA can be used as the first choice for most craniopharyngiomas patients,and endoscopic craniopharyngiomas can take GTR as the first choice.The overall PFS was satisfactory.GTR can reduce tumor recurrence and improve PFS.