Objective To evaluate the efficacy and safety of neuroendoscopic extended transnasal approach for selected craniopharyngiomas. Methods The clinical data of 16 patients underwent neuroendoscopic extended transnasal resection of craniopharyngiomas from June 2015 to December 2019 were analyzed retrospectively. Results All the tumors were removed under direct visualization. Gross-total resection was performed in 14 patients (accounting for 87.5%) and subtotal-resection in 2 patients (accounting for 12.5%). Among the 12 patients with preoperative visual impairment, the postoperative visual acuity improved in 10 patients (accounting for 83.3%) and remained unchanged in 2 patients (accounting for 16.7%). Postoperative hypopituitarism occurred in 9 cases (accounting for 56.3%) , diabetes insipidus occurred in 6 cases (accounting for 37.5%). There were 4 cases (accounting for 25%) of hyposmia, 2 cases of CSF leakage (accounting for 12.5%) and 2 cases of obesity (accounting for 12.5%), and 1 case of meningitis (accounting for 6.3%), 1 case of hydrocephalus (accounting for 6.3%) and 1 case of memory deterioration (accounting for 6.3%) occurred postoperatively. There were tumor no recurrence after 2-59 months follow- up . Conclusions The surgical resection of craniopharyngiomas by extended neuroendoscopic transnasal approach has the advantages of excellent direct visualization of the tumors, high total resection rate and high visual improvement. CSF leakage and hyposmia were the major disadvantages of this approach, so the reconstruction of skull base and the protection of nasal mucosa should be paid more attention during the surgery.
Cai Meiqin, Luo Lun, He Haiyong, Zheng Wenhan, Zhang Baoyu, Li Wensheng, Guo Ying
. Application of neuroendoscopy in extended transnasal approach for craniopharyngiomas surgery[J]. Chinese Journal of Clinical Anatomy, 2021
, 39(4)
: 469
-472
.
DOI: 10.13418/j.issn.1001-165x.2021.04.020
[1] Wannemuehler TJ, Rubel KE, Hendricks BK, et al. Outcomes in transcranial microsurgery versus extended endoscopic endonasal approach for primary resection of adult craniopharyngiomas[J]. Neurosurg Focus, 2016, 41(6): E6. DOI: 10.3171/2016.9.FOCUS16314.
[2] Chakrabarti I, Amar AP, Couldwell W, et al. Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma[J]. J Neurosurg, 2005, 102(4): 650-657. DOI: 10.3171/jns.2005.102.4.0650.
[3] Cavallo LM, Frank G, Cappabianca P, et al. The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients[J]. J Neurosurg, 2014, 121(1): 100-113. DOI: 10.3171/2014.3.JNS131521.
[4] Gardner PA, Kassam AB, Snyderman CH, et a1. Outcomes following endoscopic, expanded eudonasal resection of suprasellar craniopharyngiomas: a case series[J]. J Neurosurg, 2008, 109 (1): 6-16. DOI: 10.3171/JNS/2008/109/7/0006.
[5] Komotar RJ, Starke RM, Raper DM, et al. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas[J]. World Neurosurg, 2012, 77(2): 329-341. DOI: 10.1016/j.wneu.2011.07.011.
[6] 阮伦亮, 靳凯, 谭松, 等. 神经内镜扩大经鼻-蝶窦入路治疗颅咽管瘤的临床分析[J]. 中华神经外科杂志, 2017, 3(5): 470-474. DOI: 10.11798/j.issn.1007-1520.201704002.
[7] Shi XE, Wu B, Fan T, et al. Craniopharyngioma: surgical experience of 309 cases in China[J]. Clin Neurol Neurosurg, 2008, 110(2): 151-159. DOI: 10.1016/j.clineuro.2007.10.013.
[8] 邓昭健, 蒋其俊, 甘正凯. 眉弓入路显微手术治疗颅咽管瘤的临床应用及疗效[J]. 中国临床解剖学杂志, 2019, 37(6): 704-707. DOI: 10.13418/j.issn.1001-165x.2019.06.018.
[9] Frank G, Pasquini E, Doglietto F, et al. The endoscopic extended transsphenoidal approach for craniopharyngiomas[J]. Neurosurgery, 2006, 59(1 Suppl 1):ONS75-ONS83. DOI: 10.1227/01.NEU. 0000219 897. 98238.A3.
[10]Mou J, Wang X, Huo G, et al. Endoscopic endonasal surgery for craniopharyngiomas: a series of 60 patients [J]. World Neurosurg, 2019, S1878-8750(18)32933-4. DOI: 10.1016/j.wneu.2018.12.110.
[11]Leng LZ, Greenfield JP, Souweidane MM, et a1, Endoscopic, endonasal resection of craniopharyagiomas, analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index[J]. Neurosurgery, 2012, 70(1): l10-123, discussion 123-124. DOI: 10.1227/NEU.0b013e31822e8ffc.
[12]Laws ER. Surgical outcome in 90 patients with craniopharyngiomas: an evaluation of the transsphenoidal approach[J]. World Neurosurg, 2010, 74(2-3): 254-255. DOI: 10.1016/j.wneu.2010.07.033.
[13]Koutourousiou M, Gardner PA, Fernandez-Miranda JC, et al. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients[J]. J Neurosurg, 2013, 119(5): 1194-1207. DOI: 10.3171/2013.6.JNS122259.
[14]邓侃, 杨远帆, 包新杰, 等. 扩大经蝶窦入路颅底重建失败原因分析[J].中华显微外科杂志, 2015, 38(3): 262-265. DOI: 10.3760/cma.j.issn.1001-2036.2015.03.015.
[15]Jane JA Jr, Kiehna E, Payne SC, et al. Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas[J]. Neurosurg Focus, 2010, 28(4): E9. DOI: 10.3171/2010.1.FOCUS09319.
[16]Georgalas C, Badloe R, van Furth W, et al. Quality of life in extended endonasal approaches for skull base tumours[J]. Rhinology, 2012, 50(3): 255-261.DOI: 10.1002/lary.27630.
