Surgical treatment of craniopharyngiomas: The transsphenoidal approach

OBJECTS: Craniopharyngiomas are histologically benign tumors that represent a surgical challenge owing to the frequent involvement of critical structures such as the pituitary, the chiasm, and the hypothalamus. Transsphenoidal surgery (TSS) has been classically used for intrasellar craniopharyngiomas, but its role for the treatment of suprasellar lesions is still evolving and debated. We therefore reviewed our experience and the pertinent literature on the use of TSS for the treatment of craniopharyngiomas. PATIENTS AND METHODS: In a series of 109 patients who underwent surgery for craniopharyngiomas, TSS was the first choice of approach in 67 cases (61%) (34 females and 33 males, age range: 12 to 79 y). Follow-up ranged from 2 to 25 years (mean: 6.5 y). A standard transsphenoidal approach was used in patients with an exclusively intrasellar (13 patients) or an intrasellar and suprasellar tumor (41 patients); in 13 cases of exclusively suprasellar tumors an extended transsphenoidal presellar (10 patients) or transsellar approach (3 patients) was used, with a sublabial microscopic, endoscope-assisted technique. RESULTS: Total removal was achieved in 42 patients (63%). All patients had a good clinical outcome. Postoperative cerebrospinal fluid leakage occurred in 10 cases, but only 1 case required surgical repair of the sella. There were 9 cases (14%) of tumor regrowth. Three illustrative cases are thoroughly discussed to present the extended transsphenoidal approaches and the limits of TSS. CONCLUSIONS: When used in appropriately selected craniopharyngiomas and by neurosurgeons with extensive experience in pituitary surgery, TSS offers excellent results with minor risks. © 2009 Lippincott Williams & Wilkins, Inc.