Transsphenoidal microsurgery in the management of craniopharyngioma

TLDR

Tumor enlargement of the sella is the key factor enabling successful transsphenoidal surgery. The study presents the rationale for using a transsphenoidal approach in craniopharyngioma surgery, drawing on 26 cases. Among 26 patients, 9 of 14 had total tumor removal, 2 developed permanent diabetes insipidus, 1 operative death, and 2 cerebrospinal fluid leaks; all 12 patients with prior craniotomy achieved temporary palliation, and visual function improved in 15 of 16 patients.

Abstract

✓ The rationale for the transsphenoidal approach in the surgical management of craniopharyngioma is presented, based on experience with 26 cases. In 14 patients without prior therapy, nine had “total” removal of the lesion, and only two had permanent postoperative diabetes insipidus. One operative death occurred in this group, and two patients had cerebrospinal fluid leaks. In 12 patients who had undergone prior craniotomy, successful palliation was accomplished, at least temporarily, in every case. Vision was improved postoperatively in 15 of the 16 patients who presented with visual loss. Enlargement of the sella by the tumor is the critical feature allowing for successful transsphenoidal management.