Outcome of endoscopic endonasal surgery in pediatric craniopharyngiomas

Abstract Introduction In the last years, few reports have demonstrated the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas of pediatric age. For these tumors recent studies have suggested to prefer a less aggressive surgery, favoring the preservation of the patients quality of life. Aim of this study was to assess the outcome of the EEA in a large series with specific attention on the long term functional sequelae. Materials All consecutive pediatric craniopharyngiomas operated through this approach since 2000 have been included in the study. Pre- and post-operative operative clinical, radiological and pathological features were retrieved from patient records (mean follow-up: 72±67 months). Results The series includes 25 patients (12 female, mean age: 8.9 ± 4.1 years). Most of the tumors presented a supradiaphragmatic extension (88%). Removal was radical in 23 (92%) cases. Complications consisted of 6 (24%) CSF leaks. One patient (4%) died for post-operative respiratory complications. The majority of patients (92%) developed a panhypopituitarism and visual disturbances normalized or improved in 6 cases (43%). At follow-up, 9 patients (36%) were overweight/obese (6 of them were already overweight before surgery). Tumor recurrence rate was of 19%. Conclusions EEA can be an effective approach for midline craniopharyngiomas in children older than 3 years. It gives a satisfactory exposure of the suprasellar region and an adequate assessment of the brain-tumor interface. Its main limitations are age-related anatomical features of nasal/paranasal sinuses and the risk of CSF leak.