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Long-term neurological, visual, and endocrine outcomes
following transnasal resection of craniopharyngioma
Chakrabarti I, Amar AP, Couldwell W, Weiss MH
Department of Neurological Surgery, University of Southern California, Los
Angeles, California 90032, USA. Ichakrab@usc.edu
Object. The authors report on a cohort of patients with craniopharyngioma
treated principally through transnasal (TN) resection and followed up for a
minimum of 5 years.
More specifically, they evaluate the role of the TN
approach in the management of craniopharyngioma.
Methods. Between 1984 and
1994, 68 patients underwent TN resection of craniopharyngiomas at the
University of Southern California.
The tumor was at least partially cystic
in 88% of cases.
Four tumors were purely intrasellar, 53 had intra- and
suprasellar components, and 11 were exclusively suprasellar.
During the same
period, 18 patients underwent transcranial (TC) resection of purely
suprasellar craniopharyngiomas.
Long-term neurological, visual, and
endocrine outcomes were reviewed for all patients.
In 61 (90%) of 68
patients in the TN group, total resection was achieved, according to 3-month
postoperative magnetic resonance images, although four patients suffered a
recurrence.
Three (43%) of the seven tumors that had been partially resected
were enlarged on serial imaging.
Fifty-four (87%) of 62 patients with
preoperative visual loss experienced improvement in one or both eyes, but
two patients (3%) with exclusively suprasellar tumors experienced
postoperative visual worsening in one or both eyes.
New instances of
postoperative endocrinopathy (that is, not present preoperatively) occurred
as follows: hypogonadism (eight of 22 cases), growth hormone (GH) deficiency
(four of 18 cases), hypothyroidism (11 of 49 cases), hypocortisolemia (nine
of 52 cases), and diabetes insipidus (DI; four of 61 cases).
One case each
of hypocortisolemia and hypothyroidism resolved after surgery.
Hyperphagia
occurred in 27 (40%) of 68 patients.
One patient had short-term memory loss.
Postoperative complications included one case of cerebrospinal fluid leak.
Among the 18 patients in the TC group, 11 had complete resections.
In one
case (9%) the tumors recurred.
Three (43%) of the seven subtotally resected
tumors grew during the follow-up interval.
Vision improved in 11 (61%) of 18
cases and worsened in three (17%) as a result of surgery.
New instances of
postoperative endocrinopathy occurred as follows: hypogonadism (one of six
cases), GH deficiency (four of seven cases), hypothyroidism (11 of 14
cases), hypocortisolemia (eight of 15 cases), and DI (nine of 16 cases).
No
instance of preoperative endocrinopathy was corrected through TC surgery.
Four patients (22%) exhibited short-term memory loss and 11 (61%) had
hyperphagia after surgery.
When compared with those in the TC group,
patients in the TN group had shorter hospital stays.
Conclusions. Use of the
TN approach can render good outcomes in properly selected patients with
craniopharyngioma, particularly when the tumor is cystic.
Even in mostly
suprasellar cases, an extended TN approach can afford complete resection.
Note that endocrine function often worsens after surgery and that
postoperative obesity can be a significant problem.
PMID: 15871507 [PubMed - in process]
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