Surgical Outcomes of Endoscopic Endonasal Skull Base Surgery of Craniopharyngiomas Evaluated According to the Degree of Hypothalamic Extension

OBJECTIVE: Sparing the hypothalamus after craniopharyngioma treatment is a prerequisite to ensure a good quality of life. In this study, the functional prognosis of craniopharyngioma after endoscopic endonasal skull base surgery (EES) was examined in function of the degree of hypothalamic extension. METHODS: Twenty cases of craniopharyngioma treated by EES were categorized according to the Puget classification using preoperative and postoperative magnetic resonance imaging. The degree of resection rates, amelioration of symptoms, and endocrinologic and hypothalamic functions were evaluated during the postoperative follow-up period. RESULTS: All cases were preoperatively classified into grades 0 (n = 8), 1 (n = 7), and 2 (n = 5). Near total resection was achieved in half of the cases. Moreover, visual improvement was observed in 75% of the cases. The incidence rate of additional endocrinologic dysfunction was not related to the preoperative grade or intraoperative stalk preservation. Postoperative magnetic resonance imaging indicated hypothalamic preservation for all grades. After an average of 60 months follow-up of 11 patients with primary tumors, 4 patients showed tumor regrowth controlled by stereotactic radiation therapy. All patients recorded more than 80% on the Karnofsky Performance Scale and showed no additional obesity at follow-up. CONCLUSIONS: EES provides optimal resection rate and limited complications because of the preservation of the hypothalamus, regardless of the degree of preoperative hypothalamic involvement. Consequently, the rate of obesity occurrence is also decreased. This study indicates that EES protects hypothalamus function and improves tumor removal rate, and that it will become the first choice of surgical procedure for managing craniopharyngiomas.