Operative neurosurgery (Hagerstown, Md.) · 2025
Endoscopic Endonasal Approach for Craniopharyngiomas With Intraventricular Extension: Anatomic-Clinical Considerations and Surgical Outcomes in a Series of 61 Patients.
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Bove Ilaria, Solari Domenico, Somma Teresa, Nocini Riccardo, Palmiero Carmela, Esposito Felice, Cappabianca Paolo, Cavallo Luigi Maria
Аннотация
BACKGROUND AND OBJECTIVES: Craniopharyngiomas (CPs) with intraventricular extension has required often a difficult surgical management. These injuries involve a high degree of endocrinological, visual, and neuropsychological morbidities, which have a huge impact on the patient's quality of life. The advancements of visualization instruments along with development of minimally invasive techniques as the endoscopic endonasal have granted reduction of morbidity and mortality rates. The aim of this retrospective study was to report our experience with the endoscopic endonasal approach in the management of a series of patients affected by CPs with intraventricular extension.
METHODS: The authors reviewed data of 61 cases from a series of 164 patients, who underwent an endoscopic endonasal transtuberculum/transplanum approach for the removal of a CP involving the third ventricle between January 2001 and March 2023. Four main third ventricular growth patterns were identified: stalk-infundibulum, infundibulum-ventricular chamber, stalk-infundibulum-ventricular chamber, and ventricular chamber.
RESULTS: Sixty-one patients (34 men, 27 women), with mean age of 51.87 years (range 10-79 years ± 13.66 SD), underwent extended endoscopic endonasal approach. Gross total resection was obtained in 65.6% of cases and resulted significantly influenced by the sex (95% CI, 0.080-0.60; P = .02), previous treatment (95% CI, 0.08-0.31; P = .04), and tumor location (95% CI, 0.44-0.10; P = .05). Postoperatively, visual improvement was observed in 40 patients (76.9%). The hypothalamic functions were improved in 6 cases (20%), remained stable in 9 (45%), instead a new-onset of hypothalamic functions disturbances were registered in 5 cases on 31 patients (16.1%). Six postoperative cerebrospinal fluid leaks (9.8%) occurred.
CONCLUSION: The different topographies of intraventricular CPs affect the outcomes of resection. However, the extension of CP in the third ventricle does not represent a limit of the endonasal route; the good outcomes and limited complications confirm that.
METHODS: The authors reviewed data of 61 cases from a series of 164 patients, who underwent an endoscopic endonasal transtuberculum/transplanum approach for the removal of a CP involving the third ventricle between January 2001 and March 2023. Four main third ventricular growth patterns were identified: stalk-infundibulum, infundibulum-ventricular chamber, stalk-infundibulum-ventricular chamber, and ventricular chamber.
RESULTS: Sixty-one patients (34 men, 27 women), with mean age of 51.87 years (range 10-79 years ± 13.66 SD), underwent extended endoscopic endonasal approach. Gross total resection was obtained in 65.6% of cases and resulted significantly influenced by the sex (95% CI, 0.080-0.60; P = .02), previous treatment (95% CI, 0.08-0.31; P = .04), and tumor location (95% CI, 0.44-0.10; P = .05). Postoperatively, visual improvement was observed in 40 patients (76.9%). The hypothalamic functions were improved in 6 cases (20%), remained stable in 9 (45%), instead a new-onset of hypothalamic functions disturbances were registered in 5 cases on 31 patients (16.1%). Six postoperative cerebrospinal fluid leaks (9.8%) occurred.
CONCLUSION: The different topographies of intraventricular CPs affect the outcomes of resection. However, the extension of CP in the third ventricle does not represent a limit of the endonasal route; the good outcomes and limited complications confirm that.