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Endoscopic endonasal trans-sphenoid management of craniopharyngiomas.

Yadav YR, Nishtha Y, Vijay P, Shailendra R, Yatin K - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively.Average follow-up was 19 months.Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.

ABSTRACT

Introduction: Craniopharyngiomas treatment has been challenging because of their anatomical location. The endoscopic endonasal (EE) trans-sphenoidal approach is indicated in sellar, supra sellar, selected intraventricular lesions in adults and children. We are reporting our initial experience of 44 patients managed by EE approach.

Materials and methods: This is a retrospective study of 44 craniopharyngiomas. The goal of surgery was gross-total resection in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Lumbar drain at the start of the operation was used in all cases with tumor larger than 3 cm maximum diameter. Binostril technique vascularized nasoseptal flap and multilayer closure of the dural defect were used. Wide sphenoidotomy, posterior ethmoidectomy, tuberculum selle, and planum removal were performed in all cases. Perioperative antibiotic prophylaxis was used for 72 h.

Results: There were 44 patients of age ranging from 8 to 65 (mean: 42) years. Diameter of the tumor varied from 3.1 cm to 6.6 cm (average: 4.3 cm). Visual and pituitary dysfunctions were observed in 44 and 33, respectively, before surgery. Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively. Average follow-up was 19 months.

Conclusion: Endoscopic endonasal trans-sphenoidal approach for craniopharyngioma is safe and effective alternative to transcranial approach in selected patients. Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.

No MeSH data available.


Related in: MedlinePlus

Preoperative plain (a-f) and contrast (g-i)-computed tomography scan showing craniopharyngioma with calcification (arrow down) extending up to right side foramen of Monro causing asymmetrical dilatation of lateral ventricle (arrow to left)
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Figure 1: Preoperative plain (a-f) and contrast (g-i)-computed tomography scan showing craniopharyngioma with calcification (arrow down) extending up to right side foramen of Monro causing asymmetrical dilatation of lateral ventricle (arrow to left)

Mentions: This is a retrospective evaluation of 44 craniopharyngiomas that were treated via a fully endoscopic, endonasal, extended trans-sphenoid approach at our institute between January 2010 and December 2013. The senior author performed all surgeries. Goal of surgery was gross-total resection (GTR) in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Ophthalmological assessment consisted of visual acuity and visual field testing. Endocrinological assessment consisted of pre- and post-operative endocrinological evaluation including fasting morning cortisol, adrenocorticotropic hormone, thyroid function testing, follicle-stimulating hormone, luteinizing hormone, growth hormone, prolactin, serum sodium, and urine specific gravity. Endocrinological assessment was performed during the immediate postoperative period and then repeated at 4–6 weeks postoperatively. Preoperative computed tomography (CT) scans were performed in all patients [Figure 1], and magnetic resonance imaging (MRI) scans were done in 34 patients due to financial constrains [Figure 2]. Postoperative MRI scan with contrast were done to detect the extent of resection after 6 weeks of surgery [Figure 3].


Endoscopic endonasal trans-sphenoid management of craniopharyngiomas.

Yadav YR, Nishtha Y, Vijay P, Shailendra R, Yatin K - Asian J Neurosurg (2015 Jan-Mar)

Preoperative plain (a-f) and contrast (g-i)-computed tomography scan showing craniopharyngioma with calcification (arrow down) extending up to right side foramen of Monro causing asymmetrical dilatation of lateral ventricle (arrow to left)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352621&req=5

Figure 1: Preoperative plain (a-f) and contrast (g-i)-computed tomography scan showing craniopharyngioma with calcification (arrow down) extending up to right side foramen of Monro causing asymmetrical dilatation of lateral ventricle (arrow to left)
Mentions: This is a retrospective evaluation of 44 craniopharyngiomas that were treated via a fully endoscopic, endonasal, extended trans-sphenoid approach at our institute between January 2010 and December 2013. The senior author performed all surgeries. Goal of surgery was gross-total resection (GTR) in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Ophthalmological assessment consisted of visual acuity and visual field testing. Endocrinological assessment consisted of pre- and post-operative endocrinological evaluation including fasting morning cortisol, adrenocorticotropic hormone, thyroid function testing, follicle-stimulating hormone, luteinizing hormone, growth hormone, prolactin, serum sodium, and urine specific gravity. Endocrinological assessment was performed during the immediate postoperative period and then repeated at 4–6 weeks postoperatively. Preoperative computed tomography (CT) scans were performed in all patients [Figure 1], and magnetic resonance imaging (MRI) scans were done in 34 patients due to financial constrains [Figure 2]. Postoperative MRI scan with contrast were done to detect the extent of resection after 6 weeks of surgery [Figure 3].

Bottom Line: Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively.Average follow-up was 19 months.Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.

ABSTRACT

Introduction: Craniopharyngiomas treatment has been challenging because of their anatomical location. The endoscopic endonasal (EE) trans-sphenoidal approach is indicated in sellar, supra sellar, selected intraventricular lesions in adults and children. We are reporting our initial experience of 44 patients managed by EE approach.

Materials and methods: This is a retrospective study of 44 craniopharyngiomas. The goal of surgery was gross-total resection in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Lumbar drain at the start of the operation was used in all cases with tumor larger than 3 cm maximum diameter. Binostril technique vascularized nasoseptal flap and multilayer closure of the dural defect were used. Wide sphenoidotomy, posterior ethmoidectomy, tuberculum selle, and planum removal were performed in all cases. Perioperative antibiotic prophylaxis was used for 72 h.

Results: There were 44 patients of age ranging from 8 to 65 (mean: 42) years. Diameter of the tumor varied from 3.1 cm to 6.6 cm (average: 4.3 cm). Visual and pituitary dysfunctions were observed in 44 and 33, respectively, before surgery. Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively. Average follow-up was 19 months.

Conclusion: Endoscopic endonasal trans-sphenoidal approach for craniopharyngioma is safe and effective alternative to transcranial approach in selected patients. Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.

No MeSH data available.


Related in: MedlinePlus