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Updated: Nov 16, 2025
Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection
Published on: April 12, 2024
Treatment with endoscopic transnasal resection of hypothalamic pilocytic astrocytomas: a single-center experience
Zhuo-Ya Zhou1, Xiao-Shu Wang1, Yang Gong1
1Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Endoscopic endonasal approach (EEA) offers a direct surgical route for hypothalamic pilocytic astrocytomas (HPAs). This preliminary study shows acceptable outcomes for tumor resection and functional recovery, with in situ bone flap techniques proving reliable for reconstruction.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Pilocytic astrocytomas (PAs) are WHO grade I tumors, commonly benign in children, often originating in the cerebellum, optic pathways, or hypothalamic region.
- Traditional transcranial surgeries are used for hypothalamic PAs (HPAs), but limited research exists on the endoscopic endonasal approach (EEA) for these tumors.
Purpose of the Study:
- To report the preliminary experience and outcomes of treating hypothalamic pilocytic astrocytomas (HPAs) using the expanded endoscopic endonasal approach (EEA).
- To evaluate the safety and efficacy of the in situ bone flap (ISBF) technique for skull base reconstruction in EEA for HPAs.
Main Methods:
- Retrospective review of patients with HPAs who underwent EEA between 2017 and 2019.
- Analysis of demographic data, clinical symptoms, complications, surgical techniques, skull base reconstruction methods, prognosis, and endocrinological outcomes.
- Detailed recording and analysis of all collected patient data.
Main Results:
- Five female patients were analyzed, with an average age of 28.6 years; all presented with menstrual disorders.
- Gross-total resection was achieved in four patients; one experienced visual improvement, while another had postoperative vision worsening.
- One patient suffered intracranial infection; no CSF leaks occurred. ISBF techniques were used for reconstruction, with one case utilizing ISBF combined with a free middle turbinate mucosal flap. Three-year follow-up showed three patients alive, two disease-free, and one with severe hypothalamic dysfunction. One patient died from postoperative hypothalamus reaction, and another from recurrent pancreatitis.
Conclusions:
- The endoscopic endonasal approach (EEA) offers a direct surgical option for hypothalamic pilocytic astrocytomas (HPAs), yielding acceptable results in tumor resection and functional outcomes.
- The in situ bone flap (ISBF) technique is a safe and reliable method for skull base reconstruction in the context of EEA for HPAs.
- Further research with larger cohorts is needed due to the preliminary nature of the data.
Backgrounds:
Pilocytic astrocytomas (PAs) are World Health Organization (WHO) grade I tumors, which are relatively common, and are benign lesions in children. PAs could originate from the cerebellum, optic pathways, and third ventricular/hypothalamic region. Traditional various transcranial routes are used for hypothalamic PAs (HPAs). However, there are few studies on hypothalamic PAs treated through the endoscopic endonasal approach (EEA). This study reports the preliminary experience of the investigators and results with HPAs via expanded EEAs.
Methods:
All patients with HPAs, undergone EEA in our hospital from 2017 to 2019, were retrospectively reviewed. The demographic data, clinical symptoms, complications, skull base reconstruction, prognosis, and endocrinological data were all recorded and analyzed in detail.
Results:
Finally, five female patients were enrolled. The average age of patients was 28.6 ± 14.0. All patients had complaints about their menstrual disorder. One patient had severe bilateral visual impairment. Furthermore, only one patient suffered from severe headache due to acute hydrocephalus, although there were four patients with headache or dizziness. Four cases achieved gross-total resection, and one patient achieved subtotal resection. Furthermore, there was visual improvement in one patient (case 5), and postoperative worsening of vision in one patient (case 4). However, only one patient had postoperative intracranial infection. None of the patients experienced a postoperative CSF leak, and in situ bone flap (ISBF) techniques were used for two cases for skull base repair. In particular, ISBF combined with free middle turbinate mucosal flap was used for case 5. After three years of follow-up, three patients are still alive, two patients had no neurological or visual symptoms, or tumor recurrence, and one patient had severe hypothalamic dysfunction. Unfortunately, one patient died of severe postoperative hypothalamus reaction, which presented with coma, high fever, diabetes insipidus, hypernatremia and intracranial infection. The other patient died of recurrent severe pancreatitis at one year after the operation.
Conclusion:
Although the data is still very limited and preliminary, EEA provides a direct approach to HPAs with acceptable prognosis in terms of tumor resection, endocrinological and visual outcomes. ISBF technique is safe and reliable for skull base reconstruction.
