Endoscopic endonasal surgery for resection of primary craniopharyngioma based on QST classification

Abstract

Objective The aim of this study was to evaluate outcomes of endonasal approaches for different craniopharyngiomas types based on QST classification. Methods A total of 125 primary craniopharyngioma (CP) patients undergoing resection from January 2008 to January 2018 were reviewed. All tumors were divided into three types (Q⁃, S ⁃, and T⁃CP) according to QST classification: 38 cases with Q ⁃ CP, 20 with S ⁃ CP, and 67 with T ⁃ CP. All tumors were removed by endoscopic endonasal surgery. The gross total resection rates, the postoperative complications and the recurrence rates were recorded. Results The gross total resection rates of Q ⁃, S ⁃, and T ⁃ CP were 97.37% (37/38), 90% (18/20) and 92.54% (62/67), respectively. Visual deterioration after surgery occurred in 0 (0/38), 5% (1/20) and 1.49% (1/67) of patients. The new hypopituitarism rates were 28.95% (11/38), 25% (5/20), and 37.31% (25/67), respectively; the permanent diabetes insipidus were observed in 39.47% (15/38), 35% (7/20) and 44.78% (30/67) of patients; postoperative cerebrospinal fluid leak occurred in 13 patient, with the rate of 10.53% (4/ 38), 10% (2/20) and 10.45% (7/67) in each tumor type ; intracranial infection occurred in 5.26% (2/38), 5% (1/20) and 7.46% (5/67) of patients; hydrocephalus was noted in 5.26% (2/38), 5% (1/20) and 5.97% (5/67) of patients; Stroke or hemorrhage occurred in 2.63% (2/38), 5% (1/20) and 2.99% (2/67) of patients; nasal complications occurred in 7.89% (3/38), 10% (2/20) and 10.45% (7/67) of patients. The mortality was 0 (0/38), 5% (1/20) and 2.99% (2/67), respectively. The mean follow⁃up duration of all cases was 71.60 months, and the recurrence rate of each tumor type were 2.63% (1/38), 5% (1/20) and 4.48% (3/67), respectively. Conclusions Craniopharyngioma could be effectively cured by radical surgery. Endonasal surgery has its unique advantages when managing different types of craniopharyngioma with favorable results. Individualized surgical strategies based on tumor growth patterns are mandatory to achieve optimal outcomes of patients.DOI：10.3969/j.issn.1672⁃6731.2020.04.006