Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients

Abstract

OBJECTIVE An assessment of the transcranial approach (TCA) and the endoscopic endonasal approach (EEA) for craniopharyngiomas (CPs) according to tumor types has not been reported. The aim of this study was to evaluate both surgical approaches for different types of CPs. METHODS A retrospective review of primary resected CPs was performed. A QST classification system based on tumor origin was used to classify tumors into 3 types as follows: infrasellar/subdiaphragmatic CPs (Q-CPs), subarachnoidal CPs (S-CPs), and pars tuberalis CPs (T-CPs). Within each tumor type, patients were further arranged into two groups: those treated via the TCA and those treated via the EEA. Patient and tumor characteristics, surgical outcomes, and postoperative complications were obtained. All variables were statistically analyzed between surgical groups for each tumor type. RESULTS A total of 315 patients were included in this series, of whom 87 were identified with Q-CPs (49 treated via TCA and 38 via EEA); 56 with S-CPs (36 treated via TCA and 20 via EEA); and 172 with T-CPs (105 treated via TCA and 67 via EEA). Patient and tumor characteristics were equivalent between both surgical groups in each tumor type. The overall gross-total resection rate (90.5% TCA vs 91.2% EEA, p = 0.85) and recurrence rate (8.9% TCA vs 6.4% EEA, p = 0.35) were similar between surgical groups. The EEA group had a greater chance of visual improvement (61.6% vs 35.8%, p = 0.01) and a decreased risk of visual deterioration (1.6% vs 11.0%, p < 0.001). Of the patients with T-CPs, postoperative hypothalamic status was better in the TCA group than in the EEA group (p = 0.016). Postoperative CSF leaks and nasal complication rates occurred more frequently in the EEA group (12.0% vs 0.5%, and 9.6% vs 0.5%; both p < 0.001). For Q-CPs, EEA was associated with an increased gross-total resection rate (97.4% vs 85.7%, p = 0.017), decreased recurrence rate (2.6% vs 12.2%, p = 0.001), and lower new hypopituitarism rate (28.9% vs 57.1%, p = 0.008). The recurrence-free survival in patients with Q-CPs was also significantly different between surgical groups (log-rank test, p = 0.037). The EEA required longer surgical time for T-CPs (p = 0.01). CONCLUSIONS CPs could be effectively treated by radical surgery with favorable results. Both TCA and EEA have their advantages and limitations when used to manage different types of tumors. Individualized surgical strategies based on tumor growth patterns are mandatory to achieve optimal outcomes.

Reinvestigating Tumor–Ventricle Relationship of Craniopharyngiomas With Predominantly Ventricular Involvement: An Endoscopic Endonasal Series Based on Histopathological Assessment

“…Preoperative imaging was reviewed in each case to evaluate the location and growth pattern of the tumor in determining the potential for study inclusion. According to our QST classification based on tumor origin as reported previously ( 21 , 22 ), all tumors were classified into three types: infrasellar/subdiaphragmatic CPs (Q-CPs), subarachnoidal CPs (S-CPs), and pars tuberalis CPs (T-CPs). Confirmation of a CP with predominantly ventricular involvement was then performed by concordant assessment of three senior neurosurgeons.…”

Proton therapy for craniopharyngioma in adults: a protocol for systematic review and meta-analysis

“…The location of craniopharyngioma (eg, according to the QST classification based on the origin of the tumor and the concept of membrane). 27 3. The tumour size of craniopharyngioma (eg, greater than 4 cm and less than 4 cm).…”

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

“…Recently, with the gradual development and application of neuroendoscopy in adult craniopharyngiomas, neuroendoscopy has gradually been used for pediatrics with different tumor characteristics and different ages, which to some extent complement the defects of the simple transcranial microsurgery for craniopharyngiomas (10)(11)(12). Although some progress has been made, there are still insufficient reports in the literature for the treatment of children via extended neuroendoscopic endonasal resection of craniopharyngioma (6,10,13).…”

“…Recently, with the gradual development and application of neuroendoscopy in adult craniopharyngiomas, neuroendoscopy has gradually been used for pediatrics with different tumor characteristics and different ages, which to some extent complement the defects of the simple transcranial microsurgery for craniopharyngiomas (10)(11)(12). Although some progress has been made, there are still insufficient reports in the literature for the treatment of children via extended neuroendoscopic endonasal resection of craniopharyngioma (6,10,13). Therefore, in this study, we would retrospectively summarize the surgical cases of pediatric craniopharyngioma in our center to further explore the surgical approach and technique of neuroendoscopic endonasal resection of craniopharyngioma in children and to evaluate its surgical safety and effect as well as the postoperative management of children with craniopharyngioma.…”