Endoscopic Transnasal Surgery for Craniopharyngiomas - A Single Center Experience of 929 Patients

Introduction: Compared with traditional craniotomy, the extended endoscopic endonasal approach (EEEA) has evolved as a more reliable surgical alternative and yielded better outcomes with its unique advantages. We used the largest known case series of craniopharyngiomas resected through EEA to analyze the surgical strategy, surgical experience, postoperative complication, anatomical classification, and prognosis, which may contribute to clinical decision-making，Improving the quality of surgery and patient counseling for the application of EEEA in the treatment of craniopharyngiomas (CP).

Methods: This study included 929 CP patients who were underwent tumor resection through EEEA in our center between January 2019 and October 2024. Clinical and radiographic data were retrospectively analyzed. 929 CPs were categorized into six types based on the relationship between tumor and pituitary gland/sellar diaphragm/third ventricular floor (TVF), which was determined by preoperative imaging and intraoperative findings. Clinical characteristics, intraoperative findings, surgical experiences, postoperative complications and patient prognosis were discussed.

Results: GTR was achieved in 833 cases (89.7%). Logistic regression analysis showed that adult patients, recurrent tumor, cystic tumor, larger tumor volume, and massive calcification were independent risk factors for NGTR. The tumor recurrence rate of all patients was 12.1%. Multivariate Cox analysis showed that NGTR, Puget grading II, cystic tumor and calcification were independently associated with CPs recurrence. A larger dural defect size, Recurrent tumors, malnutrition, Extreme obesity and Intrasellar-Suprasellar Type were identified as an independent risk factor for postoperative CSF leak. Conversely, high serum albumin level was demonstrated as an independent protective factor for postoperative CSF leak.

Conclusion : The advantages of endoscopic transnasal surgery make this procedure the first choice for most children and adults with craniopharyngioma in the future. Compared with craniotomy, endoscopic transnasal surgery has its own unique surgical techniques, surgical strategies, and postoperative management details. Our clinical experience and classification of craniopharyngioma may help to better understand this procedure, which may improve the quality of surgery, and reduce the incidence of post-operative complications, and may also provide a reference for doctors and patients to choose this procedure.