Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma

Objective To discuss and analyze the outcomes, complications and progression-free survival of craniotomy and expanded endoscopic endonasal transsphenoidal surgery (EETS) of craniopharyngioma. Methods Clinical data of 58 patients with craniopharyngiomas were analyzed retrospectively who underwent 68 surgical operations at Department of Neurosurgery, Tangdu Hospital of the Air Force Medical University, from January 2006 to December 2015. Patients were separated into two groups including one group of patients underwent craniotomy (38 cases) and EETS was performed in the other group (30 cases). Intra-group comparison was conducted regarding the resection extent, complications, recurrence rate and progression-free survival. Results No significant difference was identified in the patient's age, gender, pathological classification, texture or preoperative volume of tumor between the two groups. The total resection rate of craniopharyngiomas in craniotomy group was 81.6% and 80.0% in EETS group (P=0.927). There was no significant difference in the incidence rate of panhypopituitarism (36.8% vs. 40.0%, P=0.81), diabetes insipidus (47.4% vs. 33.3%, P=0.32) or hydrocephalus (10.5% vs. 13.3%, P=0.53) between craniotomy and EETS groups. Cranial nerve injures were more commonly reported in craniotomy group than in EETS group (21.1% vs. 0%, P=0.007). The incidence rate of cerebrospinal fluid (CSF) leakage was significantly higher in EETS group than that in craniotomy group (23.3% vs. 0%, P=0.002). All patients were followed up for 19-94 months. There was no significant difference in the recurrence rate [18.4% (7/38) vs. 20.0% (6/30)], median time to recurrence (10.3 months vs. 10.8 months) or progression-free survival (25.4 months vs. 26.4 months) between the craniotomy and EETS groups (all P>0.05). Conclusions The extent of craniopharyngioma resection and outcomes of patients in EETS are comparable to those in craniotomy. EETS seems to be associated with a lower incidence rate of cranial nerve injures and a higher incidence rate of CSF leakage. Key words: Craniopharyngioma; Neuroendoscopy; Neurosurgical procedures; Comparative effectiveness research