Interdisciplinary Neurosurgery (Jun 2022)
Endoscopic trans-ventricular resection of cystic craniopharyngioma in adults associated with hydrocephalus, an alternative minimally invasive approach
Abstract
Background: Craniopharyngiomas are benign sellar and suprasellar tumors, presumed to originate from the cellular residue of Rathke’s pouch. The optimal therapeutic approach that supports the best resection with less morbidity is still debatable. This study aimed to evaluate an endoscopic trans-ventricular approach as an alternative surgical route in selected cases of cystic craniopharyngiomas invading the third ventricle and causing hydrocephalus in adults. Methods: This retrospective cohort study was conducted on 22 adult patients presenting with symptomatic cystic craniopharyngioma and operated through an endoscopic trans-ventricular approach from June 1, 2012, through June 31, 2018. Eligible patients received intensity-modulated radiotherapy median dose of 50.4 Gy (range, 49–54 Gy). The collected data included the patient’s age, gender, presenting manifestations, and postoperative follow-up assessments. Results: We found a significant decrease in the means of Evans, visual analogue score, and Dizziness Handicap Inventory indices as well as the papilledema grade on postoperative compared to preoperative assessment (p < 0.001). Twenty (90.9%) patients were shunt-independent, while 2 (9.1%) were initially shunt-independent, but later shunts were inserted. Seven out of the nine patients who had hormonal insufficiency were improved (77.8%), and two completely resolved (22.2%). Visual field changes completely resolved in 5 (33.3%) and improved in the remaining 10 (66.7%) affected patients. Conclusions: Neuroendoscopic trans-ventricular approach allowed not only immediate decompression but also tumour resection with a minimally invasive procedure. It was effective for the surgical resection of craniopharyngiomas, resulting in higher rates of visual field and endocrinal improvements and lower rates of complications. Adjuvant radiotherapy was a useful intervention for tumour control after incomplete resection.
