Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population

Vishal S Patel; Andrew Thamboo; Jennifer Quon; Jayakar V Nayak; Peter H Hwang; Michael Edwards; Zara M Patel

doi:10.1016/j.wneu.2017.08.058

Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population

World Neurosurg. 2017 Dec:108:6-14. doi: 10.1016/j.wneu.2017.08.058. Epub 2017 Aug 23.

Authors

Vishal S Patel¹, Andrew Thamboo¹, Jennifer Quon², Jayakar V Nayak¹, Peter H Hwang¹, Michael Edwards², Zara M Patel³

Affiliations

¹ Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
² Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
³ Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA. Electronic address: zmpatel@stanford.edu.

PMID: 28838874
DOI: 10.1016/j.wneu.2017.08.058

Abstract

Background: Craniopharyngiomas have traditionally been treated via open transcranial approaches. More recently, endoscopic transsphenoidal approaches have been increasingly used; however, few case series exist in the pediatric population.

Methods: A retrospective review of patients (aged <18 years) undergoing endoscopic transsphenoidal resection of craniopharyngiomas between 1995 and 2016 was performed. Preoperative data included presenting symptoms, tumor size, location, and components. Postoperative outcomes included symptom resolution, visual outcomes, endocrine outcomes, disease recurrence, and major complications.

Results: Sixteen pediatric patients with mean age of 11.0 years (range, 5-15 years) were included. The median follow-up time was 56.2 months. Mean maximal tumor diameter was 3.98 cm. Most of the tumors had suprasellar (93.8%) and intrasellar (68.8%) components. The gross total resection rate was 93.8%. The most common presenting symptoms were vision changes (81.3%) and increased intracranial pressure (56.3%). Most patients (66.7%) had their presenting symptoms resolved by their first postoperative visit. Vision improved or remained normal in 69.2% of patients. Postoperatively, new incidence of panhypopituitarism or diabetes insipidus developed in 63.6% and 46.7% of patients, respectively. New hypothalamic obesity developed in 28.6% of patients. The postoperative cerebrospinal fluid leak rate was 18.8%. One patient died of intraventricular hemorrhage postoperatively. The major complication rate was 12.5%. Disease recurrence occurred in 1 patient with gross total resection (6.3%).

Conclusions: Endoscopic transsphenoidal resection for craniopharyngiomas can achieve high rates of total resection with low rates of disease recurrence in larger tumors than previously described. However, hypothalamic-pituitary dysfunction and cerebrospinal fluid leak remain significant postoperative morbidities.

Keywords: Craniopharyngioma; Endonasal; Endoscopic; Pediatric neurosurgery; Skull base surgery.

MeSH terms

Adolescent
Cerebrospinal Fluid Leak
Child
Child, Preschool
Craniopharyngioma / surgery*
Drainage
Female
Follow-Up Studies
Humans
Lumbar Vertebrae
Male
Minimally Invasive Surgical Procedures
Neoplasm Recurrence, Local
Neuroendoscopy*
Pituitary Neoplasms / surgery*
Postoperative Complications
Retrospective Studies
Skull Base Neoplasms / surgery
Treatment Outcome
Tumor Burden