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lüll Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas Campbell PG; McGettigan B; Luginbuhl A; Yadla S; Rosen M; Evans JJNeurosurg Focus 2010[Apr]; 28 (4): E8OBJECT: The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. METHODS: Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. RESULTS: Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. CONCLUSIONS: The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Cerebrospinal Fluid Rhinorrhea/etiology[MESH]|Craniopharyngioma/*surgery[MESH]|Diabetes Insipidus/etiology[MESH]|Female[MESH]|Hemianopsia/etiology[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Nasal Cavity[MESH]|Neuroendoscopy/*methods[MESH]|Neurosurgical Procedures/methods[MESH]|Pituitary Neoplasms/*surgery[MESH]|Postoperative Complications/etiology[MESH]|Treatment Outcome[MESH]|Vision Disorders/etiology[MESH]|Visual Fields/physiology[MESH] |