Craniopharyngioma represents up to 10% of pediatric brain tumors. Although these lesions are benign, attempts at gross-total resection (GTR) can lead to serious complications. More conservative approaches have emerged but require adjuvant radiation. Endoscopic endonasal surgery (EES) aimed at GTR has the potential to result in fewer complications, but there has been limited comparison to open surgery. The authors performed a review of these two approaches within their institution to elucidate potential benefits and complication differences.
The authors performed a retrospective review of pediatric patients undergoing resection of craniopharyngioma at their institution between 2001 and 2017. Volumetric analysis of tumor size and postoperative ischemic injury was performed. Charts were reviewed for a number of outcome measures.
A total of 43 patients with an average age of 8.2 years were identified. Open surgery was the initial intervention in 15 and EES in 28. EES was performed in patients 3–17 years of age. EES has been the only approach used since 2011. In the entire cohort, GTR was more common in the EES group (85.7% vs 53.3%, p = 0.03). Recurrence rate (40% vs 14.2%, p = 0.13) and need for adjuvant radiation (20.0% vs 10.7%, p = 0.71) were higher in the open surgical group, although not statistically significant. Pseudoaneurysm development was only observed in the open surgical group. Volumetric imaging analysis showed a trend toward larger preoperative tumor volumes in the open surgical group, so a matched cohort analysis was performed with the largest tumors from the EES group. This revealed no difference in residual tumor volume (p = 0.28), but the volume of postoperative ischemia was still significantly larger in the open group (p = 0.004). Postoperative weight gain was more common in the open surgical group, a statistically significant finding in the complete patient group that trended toward significance in the matched cohort groups. Body mass index at follow-up correlated with volume of ischemic injury in regression analysis of the complete patient cohort (p = 0.05).
EES was associated with similar, if not better, extent of resection and significantly less ischemic injury than open surgery. Pseudoaneurysms were only seen in the open surgical group. Weight gain was also less prevalent in the EES cohort and appears be correlated with extent of ischemic injury at time of surgery.
ABBREVIATIONSBMI = body mass index; DWI = diffusion-weighted imaging; EES = endoscopic endonasal surgery; EOR = extent of resection; FDCA = fusiform dilatation of the carotid artery; GTR = gross-total resection; RT = radiation therapy; STR = subtotal resection.
Correspondence Phillip B. Storm: Children’s Hospital of Philadelphia, Philadelphia, PA. firstname.lastname@example.org.INCLUDE WHEN CITING Published online June 7, 2019; DOI: 10.3171/2019.4.PEDS18612.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
BendszusM, SörensenN, HofmannE, RöllE, SolymosiL: Fusiform dilatations of the internal carotid artery following surgery for pediatric suprasellar tumors. 29:304–308, 1998997367710.1159/000028742)| false
CavalloLM, FrankG, CappabiancaP, SolariD, MazzatentaD, VillaA, : The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients. 121:100–113, 201410.3171/2014.3.JNS13152124785324)| false
ClarkAJ, CageTA, ArandaD, ParsaAT, SunPP, AugusteKI, : A systematic review of the results of surgery and radiotherapy on tumor control for pediatric craniopharyngioma. 29:231–238, 20132308993310.1007/s00381-012-1926-2)| false
Di PintoM, ConklinHM, LiC, MerchantTE: Learning and memory following conformal radiation therapy for pediatric craniopharyngioma and low-grade glioma. 84:e363–e369, 201210.1016/j.ijrobp.2012.03.066)| false
ElliottRE, HsiehK, HochmT, Belitskaya-LevyI, WisoffJ, WisoffJH: Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children. 5:30–48, 20102004373510.3171/2009.7.PEDS09215)| false
ElliottRE, WisoffJH: Fusiform dilation of the carotid artery following radical resection of pediatric craniopharyngiomas: natural history and management. 28(4):E14, 201010.3171/2010.1.FOCUS0929620367358)| false
HoffmannAWarmuth-MetzMLohleKReichelJDaubenbüchelAMMSterkenburgAS: Fusiform dilatation of the internal carotid artery in childhood-onset craniopharyngioma: multicenter study on incidence and long-term outcome. Pituitary19:422–4282016
HoffmannA, Warmuth-MetzM, LohleK, ReichelJ, DaubenbüchelAMM, SterkenburgAS, : Fusiform dilatation of the internal carotid artery in childhood-onset craniopharyngioma: multicenter study on incidence and long-term outcome. 19:422–428, 20162712551110.1007/s11102-016-0722-5)| false
KanesakaNMikamiRNakayamaHNogiSTajimaYNakajimaN: Preliminary results of fractionated stereotactic radiotherapy after cyst drainage for craniopharyngioma in adults. Int J Radiat Oncol Biol Phys82:1356–13602012
KaravitakiN, BrufaniC, WarnerJT, AdamsCBT, RichardsP, AnsorgeO, : Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. 62:397–409, 200510.1111/j.1365-2265.2005.02231.x15807869)| false
KomotarRJ, StarkeRM, RaperDMS, AnandVK, SchwartzTH: Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. 77:329–341, 201210.1016/j.wneu.2011.07.01122501020)| false
KuanEC, KaufmanAC, LernerD, KohanskiMA, TongCCL, TajudeenBA, : Lack of sphenoid pneumatization does not affect endoscopic endonasal pediatric skull base surgery outcomes. 129:832–836, 201910.1002/lary.2760030520033)| false
LengLZGreenfieldJPSouweidaneMMAnandVKSchwartzTH: Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery70:110–1242012
LengLZ, GreenfieldJP, SouweidaneMM, AnandVK, SchwartzTH: Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. 70:110–124, 201210.1227/NEU.0b013e31822e8ffc21937943)| false
NetsonKLConklinHMWuSXiongXMerchantTE: Longitudinal investigation of adaptive functioning following conformal irradiation for pediatric craniopharyngioma and low-grade glioma. Int J Radiat Oncol Biol Phys85:1301–13062013
OndruchA, MaryniakA, KropiwnickiT, RoszkowskiM, DaszkiewiczP: Cognitive and social functioning in children and adolescents after the removal of craniopharyngioma. 27:391–397, 20112093120410.1007/s00381-010-1301-0)| false
OstromQT, GittlemanH, FulopJ, LiuM, BlandaR, KromerC, : CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008–2012. 17 (Suppl 4):iv1–iv62, 201510.1093/neuonc/nov189)| false
PorettiA, GrotzerMA, RibiK, SchönleE, BoltshauserE: Outcome of craniopharyngioma in children: long-term complications and quality of life. 46:220–229, 200410.1111/j.1469-8749.2004.tb00476.x15077699)| false
RosenfeldA, ArringtonD, MillerJ, OlsonM, GiesekingA, EtzlM, : A review of childhood and adolescent craniopharyngiomas with particular attention to hypothalamic obesity. 50:4–10, 20142418890710.1016/j.pediatrneurol.2013.09.003)| false
ScarzelloGBuzzaccariniMSPerilongoGViscardiEFagginRCarolloC: Acute and late morbidity after limited resection and focal radiation therapy in craniopharyngiomas. J Pediatr Endocrinol Metab19 (Suppl 1):399–4052006
ScarzelloG, BuzzaccariniMS, PerilongoG, ViscardiE, FagginR, CarolloC, : Acute and late morbidity after limited resection and focal radiation therapy in craniopharyngiomas. 19 (Suppl 1):399–405, 200616700317)| false
SchoenfeldA, PekmezciM, BarnesMJ, TihanT, GuptaN, LambornKR, : The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. 108:133–139, 201210.1007/s11060-012-0806-722350375)| false
SuttonLN, GusnardD, BruceDA, FriedA, PackerRJ, ZimmermanRA: Fusiform dilatations of the carotid artery following radical surgery of childhood craniopharyngiomas. 74:695–700, 199110.3171/jns.1991.74.5.06952013769)| false
YamadaSFukuharaNYamaguchi-OkadaMNishiokaHTakeshitaATakeuchiY: Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study. J Neurosurg Pediatr21:549–5622018
YamadaS, FukuharaN, Yamaguchi-OkadaM, NishiokaH, TakeshitaA, TakeuchiY, : Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study. 21:549–562, 20182960090510.3171/2017.10.PEDS17254)| false
YanoS, KudoM, HideT, ShinojimaN, MakinoK, NakamuraH, : Quality of life and clinical features of long-term survivors surgically treated for pediatric craniopharyngioma. 85:153–162, 201610.1016/j.wneu.2015.08.05926341425)| false