Is low-lying optic chiasm an obstacle to endoscopic endonasal approach for retrochiasmatic craniopharyngiomas? (KOSEN-003†).

Is low-lying optic chiasm an obstacle to endoscopic endonasal approach for retrochiasmatic craniopharyngiomas? (KOSEN-003†).

World Neurosurg. 2018 Mar 07;:

Authors: Kim KH, Kim YH, Dho YS, Kim JH, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Park CK, Kong DS

Abstract
OBJECTIVE: Despite advances in endoscopic techniques, retrochiasmatic craniopharyngiomas are difficult to remove completely, because the low-lying optic chiasm often provides an obstacle to endoscopic endonasal approach. This study aimed to identify the endoscopic surgical outcomes of the retrochiasmatic CP and resolve the issues related to the low-lying optic chiasm.
METHODS: The authors reviewed 154 consecutive patients with craniopharyngioma who underwent endonasal endoscopic resection from February 2009 to April 2017 at two independent institutions. The topographical relationship of the tumor with the third ventricle, stalk, and optic chiasm and clinical outcomes were investigated.
RESULTS: Retrochiasmatic craniopharyngiomas were found in 142 (92.2%) out of 154 patients. The median follow-up time was 25 months. Gross and near-total resection were achieved in 113 patients (79.6%) and 21 patients (13.8%), respectively. Postoperative cerebrospinal fluid leaks were found in 16 patients (11.3%). Low-lying and high-lying chiasm were found in 44 patients (31.0%) and 98 patients (69.0%), respectively. Low-lying chiasm did not affect clinical outcomes including the extent of resection. The patients with the low-lying chiasm showed a marginal trend for postoperative visual deterioration. The ventricular growth pattern representing the origin of the tumor and prior surgery were significantly associated with the position of the optic chiasm (p=0.007 and 0.001, respectively).
CONCLUSIONS: Endoscopic endonasal approach is an effective surgical approach for retrochiasmatic CP, even in tumors with the low-lying chiasm. However, a thorough and careful dissection is necessary to prevent visual deterioration.

PMID: 29524705 [PubMed - as supplied by publisher]

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