Transnasal surgery in the treatment of craniopharyngiomas

Abstract

The results of transnasal-transsphenoidal surgery in 31 patients with craniopharyngioma are evaluated. To assess the value of transnasal surgery in cases with visual impairment, the results are compared to cases operated transcranially. There was only one death occurred on the 5th postoperative day. Two patients developed rhinoliquorrhoea, and one a transient oculomotor palsy. Recurrences leading to re-operation occurred frequently after mere cyst aspiration and only once after subtotal tumour removal. Normal glandotrope functions of the hypophysis were preserved in 75%, disturbed functions were normalized in 19% of primary transnasal surgery. Visual disturbances were normalized or improved in 94% cases after transnasal surgery, whereas an improvement was observed in only 65% after transcranial surgery. A deterioration never appeared after transnasal surgery, but in 26% after transcranial operations.

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

“…Visual improvement after transnasal resection of craniopharyngiomas has been reported in 50 to 93% of patients. 3,6,9,11,13,15,20,23,24,37,38,49,53 In the present series, visual acuity and field deficits had either improved (85.7%) or resolved (42.9%) in most patients at 1 month follow-up. In series including radical resections, the rate of visual deterioration is approximately 15%.…”

“…42,53 Authors have reported GTR rates ranging from 5 to 90%. 3,5,7,9,14,20,26,37,40,42,47,[51][52][53]56 Yaşargil et al 56 was able to achieve a 90% GTR rate, but reported a 9.0% rate of intraoperative and early postoperative mortality and a 16.7% overall mortality rate. Given the morbidity and mortality associated with GTRs, some investigators have advocated STR combined with postoperative radiation as an alternative when the risk of a GTR would likely be associated with formidable morbidity.…”

Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

“…[1,14,15,20] In our recent series, 27.8% of all patients with craniopharyngiomas had sellar involvement. The transsphenoidal approach is the optimum procedure for intrasellar and suprasellar infradiaphragmatic craniopharyngiomas.…”

“…[21,23,24] A transsphenoidal approach is chosen when a craniopharyngioma is located either totally or partially within an enlarged sella turcica and has only a limited suprasellar component; several small series concerning this topic have been published. [1,4,[7][8][9]11,13,14,16,20] The anatomical situation makes it more difficult to avoid further damage to the pituitary gland with total tumor removal because the gland has to be incised or dislocated to access the tumor. Since 1971 we have subtotally resected most of the latter-described tumors via a transnasal approach; the senior author has published the results over the period of 1971 to 1984.…”

“…Since 1971 we have subtotally resected most of the latter-described tumors via a transnasal approach; the senior author has published the results over the period of 1971 to 1984. [14] Magnetic resonance (MR) imaging, which provides detailed information about tumor location and extent, [22] is extremely helpful in planning the surgical approach. Moreover, pressure-irrigation-suction systems and mirror techniques allow removal of extrasellar tumor components under visual control.…”