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. 2024 Jan-Mar;15(1):74-80.
doi: 10.25259/JNRP_364_2023. Epub 2023 Sep 18.

Factors predicting outcomes of endoscopic endonasal approach in craniopharyngioma patients

Chin Taweesomboonyat  1 , Raywat Noiphithak  2 , Pree Nimmannitya  2 , Sakchai Sae-Heng  1
Affiliations

Factors predicting outcomes of endoscopic endonasal approach in craniopharyngioma patients

Chin Taweesomboonyat et al. J Neurosci Rural Pract. 2024 Jan-Mar.

Abstract

Objectives: Endoscopic endonasal approach (EEA) is commonly used for resection of craniopharyngioma (CP). Treatment outcomes of EEA for CP were related to numerous factors; however, they have been evaluated in few studies. The objective of this study is to investigate factors associated with the outcomes of CP following this operation.

Materials and methods: The records of patients with CP, who underwent EEA at our institution from January 2014 to June 2022, were retrospectively reviewed. Surgical outcomes, including the extent of resection, visual recovery, and endocrinological outcomes, were reported. Clinical and radiographic factors were analyzed for their associations with treatment outcomes using logistic regression analyzes.

Results: This study cohort consisted of 28 patients with CP. Gross total resection (GTR) was achieved in 12 patients (43%). Post-operative visual status improved, stabilized, and deteriorated in 89%, 6%, and 6% of the patients, respectively. There were no patients recovered from pre-operative pituitary dysfunctions, while post-operative hypoadrenalism, hypothyroidism, and hypogonadism were found in 9 (36%), 11 (42%), and 4 (22%) patients, respectively. Post-operative permanent diabetic insipidus was found in 13 patients (50%). Greater suprasellar extension of the tumor was associated with a lower rate of GTR (P = 0.011). Diabetes mellitus (DM) was associated with poor visual recovery (P = 0.022). Larger tumor size and Puget grade 2 were associated with postoperative hypoadrenalism (P = 0.01 and 0.023, respectively). In addition, Puget grade 2 was associated with post-operative hypothyroidism (P = 0.017).

Conclusion: For EEA in CP, the extent of resection could be determined by suprasellar extension of the tumor. DM was a poor predicting factor for visual recovery, while larger tumors and Puget grade 2 had a higher risk of post-operative hypopituitarism.

Keywords: Craniopharyngiomas; Endocrinological outcome; Endoscopic endonasal approach; Extent of resection; Predicting factors; Transsphenoidal surgery; Visual recovery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Measurement of suprasellar extension. An imaginary line was drawn from the TS to the DS, and the suprasellar extension was measured by a perpendicular line from the imaginary line to the superior-most part of the lesion. TS: Tuberculum sellae, DS: Dorsum sellae
Figure 2:
Figure 2:
Magnetic resonance imaging of example cases showing suprasellar extension of craniopharyngioma as a predictor of extent of resection. (a) A case with an 8-mm suprasellar extension of the tumor (b) achieved gross total resection (c). A case with a 22.3-mm suprasellar extension of the tumor (d) achieved subtotal resection.
Figure 3:
Figure 3:
Magnetic resonance imaging of example cases showing hypothalamic involvement of craniopharyngioma as a predictor of endocrinological outcomes. (a) A case with a Puget grade 0 (b) underwent total tumor resection with post-operative normal pituitary function (c). A case with a Puget grade 2 (d) underwent subtotal tumor resection with postoperative panhypopituitarism.
See this image and copyright information in PMC

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