2026 Poster Presentations
P290: A 15-YEAR SINGLE-CENTER EXPERIENCE WITH TRANSCRANIAL VS. ENDOSCOPIC ENDONASAL RESECTION OF CRANIOPHARYNGIOMAS
Ankit Patel; Elliot Pressman; Samantha Schimmel; Molly Monsour; Harry Van Loveren; Siviero Agazzi; Kunal Vakharia; University of South Florida Morsani College of Medicine
Introduction: Craniopharyngiomas are benign but often locally aggressive tumors that present unique operative challenges at the skull base due to their proximity to critical visual, vascular, and endocrine structures. Over the past two decades, techniques for surgical resection of these tumors have shifted from predominantly transcranial approaches toward endoscopic endonasal techniques. Our objective was to compare procedural outcomes of endoscopic endonasal versus transcranial surgery for craniopharyngiomas at our center.
Methods: We conducted a retrospective review of patients managed surgically for pathology-confirmed craniopharyngiomas at our quaternary referral center from March 2008 to February 2023. Patients were divided into endoscopic endonasal vs. craniotomy cohorts. Baseline variables collected included age, symptomatic complaint of vision loss, hydrocephalus, and baseline panhypopituitarism. Outcomes of interest included rate of gross-total or near-total resection (GTR/NTR), postoperative CSF leak, visual outcomes (worsened, stable, improved), cranial nerve III neuropathy, transient or permanent diabetes insipidus (DI), new-onset panhypopituitarism, meningitis, other intracranial infections, and 90-day postoperative mortality. Continuous variables are reported as median [Interquartile Range (IQR)].
Results: Fifty-nine tumors were identified from 55 unique patients (29 endoscopic; 30 craniotomy). Median age was 47 [IQR: 27–60] for the endoscopic patients versus 52 [IQR: 41–59.25] for the craniotomy patients (p = 0.622). Rates of baseline symptoms were similar between groups, including complaint of vision loss (endoscopic (E): 86.7% vs. craniotomy (C): 75.9%, p = 0.333), hydrocephalus (E: 6.7% vs. C: 20.7%, p = 0.145), and panhypopituitarism (E: 16.7% vs. C: 14.3%, p > 0.999). Endoscopic surgery was associated with significantly higher rates of GTR/NTR (E: 66.7% vs. C: 28.6%, p = 0.005). Postoperative CSF leak rates were not significantly different between groups (E: 20.0% vs. C: 6.9%, p = 0.254). Symptomatic visual outcomes were also similar between groups: worsened vision (E: 16.7% vs. C: 17.2%, p > 0.999), stable vision (E: 33.3% vs. C: 41.4%, p = 0.596), and improved vision (E: 46.7% vs. C: 34.5%, p = 0.430). Endoscopic cases demonstrated a reduced rate of postoperative cranial nerve III neuropathy (E: 0% vs. C: 28.6%, p = 0.002). Rates of transient DI (E: 10.0% vs. C: 28.0%, p = 0.158) and permanent DI (E: 73.3% vs. C: 57.1%, p = 0.270) were similar, though endoscopic patients were more likely to develop new onset panhypopituitarism (E: 70.0% vs. C: 41.4%, p = 0.037). Postoperative meningitis (E: 6.7% vs. C: 3.4%, p > 0.999) and other intracranial infections (E: 6.7% vs. C: 3.4%, p > 0.999) were uncommon with comparable prevalence in both groups. 90-day postoperative mortality was rare (E: 0% vs. C: 3.4%, p > 0.999).
Conclusions: In this single-center retrospective study, endoscopic endonasal resections for craniopharyngiomas, when compared to transcranial approaches, were effective and associated with higher rates of GTR/NTR and lower rates of cranial nerve III deficits, but at the cost of higher rates of postoperative panhypopituitarism, with otherwise comparable rates of complication and mortality.