Comparative analysis of the outcomes of craniotomy and endoscopic resection for recurrent craniopharyngioma: a single institution study.

backgroundCraniopharyngioma consistently represents one of the most challenging diseases encountered by neurosurgeons and has a high recurrence rate. Currently, there is still no consensus on the surgical approach for recurrent craniopharyngioma. The purpose of this study was to compare the surgical outcomes and prognoses of endoscopic endonasal surgery (EES) with those of transcranial surgery (TCS) for recurrent craniopharyngioma.

methodsA retrospective study was conducted on patients with craniopharyngioma who underwent surgical resection at Tangdu Hospital, Air Force Medical University, between January 2013 and December 2023. Patients who did not undergo surgery or who underwent primary surgery were excluded. Patients were separated into two groups based on the surgical approach. Specifically, one group underwent EES, and the other cohort underwent TCS. Patient demographic data, presenting symptoms, postoperative complications, and prognostic data were collected and analyzed. Student’s t test and the chi-square test were used to evaluate differences in patient demographics, tumor characteristics, and surgical outcomes between the two cohorts. A Kaplan-Meier curve was used to compare progression-free survival (PFS) and overall survival (OS) after reoperation between the two groups.

resultsA total of 399 patients who were diagnosed with craniopharyngioma were identified, 91 of whom had recurrent craniopharyngioma and met the inclusion criteria. Among these patients, 57 patients underwent TCS, whereas 34 patients received EES. Postoperatively, comparisons of the extent of tumor resection, intraoperative blood transfusion volume, postoperative hospital stay length, incidence of diabetes insipidus, and in-hospital mortality rate revealed no statistically significant differences. However, the EES group exhibited a greater incidence of postoperative cerebrospinal fluid (CSF) leakage than did the TCS group (14.71% vs. 0%,respectively; p = 0.006). Conversely, the EES group exhibited a greater rate of improvement in visual field defects (82.35% vs. 42.11%, p = 0.001), a shorter operative time (3.99 ± 1.97 hours vs. 4.86 ± 1.85 hours, p = 0.037), and a lower incidence of new onset of hypopituitarism (14.71% vs. 36.84%, p = 0.031). The average follow-up duration was 33.5 months (ranging from 4 to 51 months). There were no statistically significant differences observed in the PFS or OS between the TCS and EES groups.

conclusionsBoth EES and TCS are effective methods for the resection of recurrent craniopharyngioma. Although the degree of resection, PFS and OS after the second surgery were comparable between the two surgical approaches, the EES group demonstrated several advantages compared with the TCS group, although a high risk of CSF leakage was noted with EES. Therefore, the endoscopic transnasal approach is a safe and effective surgical approach for the removal of recurrent craniopharyngioma, achieving equivalent resection outcomes while minimizing complications.