Extended transsphenoidal surgery for suprasellar craniopharyngiomas: infrachiasmatic radical resection combined with or without a suprachiasmatic trans-lamina terminalis approach

Background: An extended transsphenoidal approach allowed for direct midline exposure of the parasellar structures such as the hypothalamic-pituitary axis and the third ventricle. To evaluate the capability of this approach for removal of suprasellar craniopharyngiomas, surgical outcomes were retrospectively analyzed. Methods: During a 9-year period, 20 consecutive patients with suprasellar craniopharyngioma underwent transsphenoidal tumor resection. The average follow-up period was 55 months. No patient had a purely intrasellar tumor, 9 had prechiasmatic tumors, 9 had retrochiasmatic tumors, and 2 had purely intraventricular tumors. Results: Total resection was achieved in 86% of operations. Even in mostly intraventricular cases, a transsphenoidal trans-lamina terminalis approach afforded complete resection. Visual improvement and preservation of the pituitary stalk were achieved in 84% and 95% of cases, respectively. New postoperative deterioration of pituitary function occurred in about 65% of cases, and no patient resolved their preoperative hormonal disturbance after surgery. The overall percentage of patients with diabetes insipidus increased to 61% postoperatively from 11% preoperatively. Nonendocrinologic surgical complications were observed: worsening of vision in 3 patients, hyperphagia in 3 patients, short-term memory loss in 2 patients, and cerebrospinal fluid leakage in 3 patients. Recurrence after total resection occurred in 2 (11%) patients with retrochiasmatic tumors. Conclusions: Reasonable surgical results in this study suggest that the extended transsphenoidal approach is safe and effective for removal of craniopharyngiomas. Although preservation of the pituitary stalk can be achieved in a high percentage of patients, postoperative endocrinopathy still remains as a significant problem after radical removal of the craniopharyngioma. (C) 2009 Elsevier Inc. All rights reserved.