Preservation of anterior and posterior pituitary function during transnasal endoscopic surgery of craniopharyngiomas
EANS Academy. Guk M. 09/27/19; 276030; EP04077
Dr. Mykola Guk
Dr. Mykola Guk

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Balance between radical tumor removal and quality of life remains a dilemma in surgery for craniopharyngiomas (CPs). Endoscopy shows a good challenge for radical and safe surgery for most types of CPs, but preservation of pituitary function is unlikely possible.
Goal: To study results of transnasal endoscopic removal of CPs in adults and aspects of surgical technique transformation regarding the endocrine outcome.
Materials and methods: 70 consecutive cases of CPs in adults operated endoscopically transnasally in Transsphenoidal dept. of Romodanov Neurosurgery Institute in 2015-2018. 18- infra-, 3 - infrasupra-, 59 - supradiaphragmatic (extended transplanum transtuberculum approach was used, posterior clinoidectomy were used in 5 cases of big retrosellar extension). In 2 supradiaphragmatic cases full pituitary transposition, in 5 - cases hemi (partial) pituitary transposition was performed. In 36 of supradiaphragmatic cases (61%) stalk was anatomically preserved, in 23 (39%) - sacrificed.
Results: Total and near-total removal was achieved in 53 cases (75.7%), partial - in 15 (21.4%), 2 - biopsy and cyst aspiration only (2.9%). 1 patient (1.4%) with supradiaphragmatic extra-intraventricular CF died after total removal because of diencephalic dysfunction. Endocrine deterioration with hypopituitarism were observed in all infra - and infrasupra- diaphragmatic cases (n=21), and DI in 19 (90%) of those patients. All 22 survived pts with sacrificed stalk had a DI and severe deterioration of anterior pituitary function in 18 (82%) cases. Severe endocrine deterioration was observed only in 8 cases of 36 stalk-preserved cases (22,2%), with newly-developed DI in 6 (16,6). There was 1 pituitary transposition case in this group, but all pts with hemitransposition showed satisfactory post-op anterior pituitary function.
Conclusions: Infradiaphragmatic cases are slightly possible for pituitary function preservation. Selected cases of big supradiaphragmatic CF can be challenging for radical surgery with satisfactory endocrine outcome using stalk preservation and pituitary hemitransposition endoscopic techniques.
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