Endoscopic endonasal approach for recurrent craniopharyngioma in adults

An endoscopic endonasal approach (EEA) is widely adopted for most craniopharyngioma surgeries due to its favorable clinical outcome. However, its role in recurrent tumors has not been fully assessed. The aim of this study was to analyze the surgical outcome of EEA in recurrent craniopharyngioma, assessing factors associated with radical resection and progression-free survival (PFS).

Consecutive patients with craniopharyngioma treated with surgery using an EEA at a single institution (1998-2024) were retrospectively reviewed. Those who met the inclusion criteria were divided into recurrent (prior treatment) and treatment-naive (no prior treatment) groups. Preoperative patient- and tumor-related features, surgical and clinical outcomes at follow-up, and complications were assessed and compared between the two groups.

Overall, 126 patients (69 female, mean age 51.1 years) with craniopharyngioma treated using the EEA were included, 31 (24.6%) with recurrence and 95 (75.4%) who were treatment-naive. In the recurrent group, radical resection was achieved in 24 patients (77.4%), and the most common complication was CSF leakage (19.4%). No significant differences were observed for rates of resection and morbidity between the two groups. Radical resection of recurrent craniopharyngioma was associated with a previous transcranial surgical approach (p = 0.030) and a lower preoperative BMI (p = 0.014). In the overall cohort, longer PFS was correlated with no intraventricular extension (p = 0.004) and radical resection (p < 0.001).

EEA proved to be a valid option for strictly selected patients with recurrent craniopharyngioma, with surgical and clinical outcome similar to those observed for treatment-naive patients. Radical resection and PFS were associated with both biological and technical factors, which should be taken into account in surgical planning and preoperative patient counseling.