CR-20EVOLVING TRANS-SPHENOIDAL SURGICAL MANAGEMENT OF PAEDIATRIC CRANIOPHARYNGIOMAS: A SINGLE SURGEON'S EXPERIENCE

Abstract

Introduction: Craniopharyngioma develops from residual cells of Rathke's pouch. It represents 2.5-4% of all brain tumours, and half present in childhood with a peak incidence at 5-10 years. Surgical resection is performed to prevent hydrocephalus, bitemporal hemianopia and endocrine imbalance. Operative approaches include craniotomy by frontooral or trans-callosal routes and more recently trans-sphenoidal (endoscopic and microscope assisted). We present our experience using the trans-sphenoidal approach.Methods: Retrospective analysis was undertaken for all paediatric cases of craniopharyngioma operated using the trans-sphenoidal approach between January 2000 and January 2014 at a single institution. Data on demographics, operative details, complications, and extent of resection based on comparison of pre-and post-operative magnetic resonance imaging (MRI) were collected. Results: During the study period 8 cases were operated: three trans-sphenoidal microscopic and five trans-sphenoidal endonasal. Male-to-female ratio was 5:3 and mean age was 13 years (range, 8-17 years). 4 of 8 cases had been previously operated with craniotomy. All cases used a combined neurosurgical-otolaryngology approach and frameless stereotactic neuro-navigation. Gross total resection (. 95% tumour volume) was achieved in all 8 cases. Post-operative complication rate was 25% (2/8) including cerebrospinal fluid (CSF) leak (1/8, 12.5%) and diabetes insipidus (1/8, 12.5%). At two-year follow-up there has been no instance of recurrence. Conclusion: Gross total resection can be consistently achieved with the endoscopic trans-sphenoidal approach. Neuro-navigation may improve safety of the operation. Increasing endoscopic experience can lead to adoption of a pure endoscopic approach, as in our institution.