Endoscopic transsphenoidal surgery for infradiaphragmatic craniopharyngiomas and impact of diaphragm sellae competence on hypothalamic injury

• Published in: Scientific reports 2024-12, Vol.14 (1), p.30127-10
• Main Authors: Gong, Xuan, Chen, Zhou, Yang, Kui, Li, Chuntao, Feng, Songshan, Zhang, Mingyu, Liu, Zhixiong, Zhou, Hongshu, Li, Zhenyan
• Format: Article
• Language: English
• Subjects: 692/163; 692/700/565/2775; 692/700/565/545/379; Adolescent; Adult; Aged; Child; Complication; Craniopharyngioma; Craniopharyngioma - diagnostic imaging; Craniopharyngioma - surgery; Diabetes insipidus; Diaphragm; Diaphragm - surgery; Endoscopic transsphenoidal surgery; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Female; Humanities and Social Sciences; Humans; Hypopituitarism; Hypothalamic injury; Hypothalamus; Hypothalamus - diagnostic imaging; Hypothalamus - pathology; Hypothalamus - surgery; Infradiaphragmatic; Magnetic Resonance Imaging; Male; Middle Aged; multidisciplinary; Multivariate analysis; Patients; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Postoperative Complications - etiology; Retrospective Studies; Risk factors; Science; Science (multidisciplinary); Sella Turcica - diagnostic imaging; Sella Turcica - pathology; Sella Turcica - surgery; Subtype; Surgery; Surgical outcomes; Treatment Outcome; Tumors; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-81347-5

Investigate the impact of diaphragm sellae competence on surgical outcomes and risk factors for postoperative hypothalamic injury (HI) in patients undergoing endoscopic transsphenoidal surgery (ETS) for infradiaphragmatic craniopharyngiomas (ICs). A retrospective analysis of 54 consecutive patients (2016–2023) with ICs treated by ETS was conducted. All tumors originated from the sellar region inferior to the diaphragm sellae and were classified into two subtypes in terms of diaphragm sellae competence: IC with competent diaphragm sellae (IC-CDS) and IC with incompetent diaphragm sellae (IC-IDS). Clinical features, intraoperative findings, and follow-up data were compared between subtypes. Postoperative HI was assessed using an magnetic resonance imaging-based scoring system. Fifty-four patients (29 males, 25 females) were included in this study, with 12 (22.2%) under 18 years old. Overall, 35 cases were IC-CDS, while 19 were IC-IDS. Compared with IC-CDS, patients with IC-IDS tended to have hormone hypofunction before surgery ( p  = 0.03). Tumor volume in IC-IDS group (9.0 ± 8.6 cm 3 ) was also higher than that in IC-CDS group (3.3 ± 3.4 cm 3 , p  = 0.011). Thirty-seven patients underwent standard endoscopic transsphenoidal approach (SEA) and 17 underwent an extended endoscopic transsphenoidal approach (EEA). Gross total resection (GTR) was achieved in 50 cases (92.6%). Postoperative CSF leak was observed in four patients (7.4%). Permanent diabetes insipidus (DI) occurred in 13 patients (27.7%), six in IC-CDS and seven in IC-IDS. Postoperative HI occurred in 38.9% of patients. Univariate analysis revealed that large tumor size ( p  = 0.014), prior hypopituitarism( p  = 0.048) and IC-IDS ( p