Turkish Neurosurgery
Effect of Resection and Surgical Experience on Survival in Patients with Craniopharyngiomas: Endoscopic Transsphenoidal Surgery in Series of 31 Cases
Buruc Erkan1, Ozan Barut1, Ebubekir Akpinar1, Mehmet Sait Cil1, Suat Demir1, Yusuf Kilic1, Osman Tanriverdi1, Esra Suheda Hatipoglu2, Omur Gunaldi1
1University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Neurosurgery Clinic, Istanbul,
2University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Endocrinology and Metabolism Clinic, Istanbul,
DOI: 10.5137/1019-5149.JTN.46067-23.1

Aim:Craniopharyngiomas, despite their benign histology, pose challenges due to their local invasiveness and heterogeneity. Endoscopic endonasal transsphenoidal (EETS) surgery has gained prominence for treating craniopharyngiomas. This study shares the surgical outcomes of 31 patients undergoing EETS at a single center.Material and Methods:This retrospective analysis of 31 craniopharyngioma cases (2013–2022) with a minimum 6-month follow-up included demographic data, preoperative findings, postoperative resection volumes, recurrence rates, pathological diagnoses, and complications.Results:Herein, 34 EETS surgeries were performed on 31 patients (12 males, 19 females). The presenting symptoms included visual loss (58%), hypopituitarism (54.8%), and diabetes insipidus (25.8%). Gross total resection was achieved in 87% of the patients, with 64.5% total and 22.5% near-total resection. Total resection prevented recurrences, contrasting with 75% recurrence in the subtotal resection patients (p = 0.000). The primary patients showed 73.1% total resection, while only 20% of the recurrent patients achieved it (p = 0.049). Later, the patients exhibited statistically significant improvements in the resection rates (p = 0.040) and recurrence-free survival (p = 0.020). Patients with preoperative visual loss demonstrated 94.4% improvement or stability postoperatively. Postoperative complications included hypopituitarism (71.4%), permanent diabetes insipidus (60.8%), worsening vision (6.5%), cerebrospinal fluid leakage (9.7%), meningitis (6.5%), and a 3.2% perioperative mortality rate.Conclusion:This study underscores the role of surgical resection in craniopharyngiomas, emphasizing the impact of surgical experience on recurrence-free survival. Primary surgery, with minimal complications and maximal resection, is crucial in managing recurrence challenges. Endoscopic endonasal transsphenoidal surgery, particularly in experienced centers, offers advantages such as panoramic vision and access to the third ventricle base, facilitating total and near-total resection and extending recurrence-free survival.

Corresponding author : Buruc Erkan