Objectives: While the endoscopic endonasal approach (EEA) has become a well-established option for resection of craniopharyngiomas (CP), the utility of this procedure following prior open transcranial approach (TCA) surgery has been studied to a limited degree. Here we present a multi-institutional case series of patients who underwent EEA for resection of recurrent or progressive CP after previous TCA to investigate the endocrinological and visual outcomes achieved as well as the associated complication rate.
Design: Retrospective cohort
Setting: University of Pittsburgh Medical Center and Loyola University Medical Center
Participants: Patients who underwent EEA for recurrent or progressive CP following an initial TCA over a 15 year period between 2003 and 2018.
Primary Outcome Measures: Surgical complications, visual outcomes, and endocrine outcomes
Results: Thirteen patients met inclusion criteria. Three patients had incomplete medical records from outside facilities at which TCA was performed and therefore could not undergo evaluation of outcomes and complication rates from TCA. Analysis revealed that EEA was not associated with worsening of visual outcomes as compared to the initial TCA (0% worsened vision postoperatively after EEA vs 40% after initial TCA, p=0.055). While primary TCA resulted in worsening endocrinopathies in 100% of patients, subsequent EEA achieved stable (30.8%) to improved (69.2%) endocrine function in all patients; this difference vs primary TCA was statistically significant (p<0.001). Five (50%) of patients experienced postoperative complications after TCA, whereas 2 (15.4%) experienced complications after EEA (1 CSF leak and 1 sphenoid sinus infection).
Conclusions: EEA showed efficacy and safety for resection of recurrent CP after a prior TCA. Endocrinologic and visual outcomes were stable to improved after EEA in all patients evaluated in this study. We conclude that EEA should be considered for re-resection in cases of progressive or recurrent CP following prior TCA.