Objective:

To compare perioperative and follow-up outcomes, including extent of resection, length of stay, complications, endocrine outcomes, visual outcomes, postoperative radiotherapy, and recurrence/progression, between endoscopic endonasal approach (EEA) and transcranial craniotomy (TCA) for craniopharyngioma resection.

Approach:

• Outcome Measures: Outcomes included extent of resection, length of stay, complications, axis-specific endocrine outcomes and replacement burden at 6 months, objective visual outcomes at 3 months, postoperative radiotherapy, and recurrence/progression at last follow-up.

Key Findings:

• EEA achieved a higher gross total resection (GTR) rate (82.4% vs. 45.5%, p=0.002).
• EEA resulted in a shorter hospital stay (16.19 ± 3.97 vs. 18.76 ± 4.23 days, p=0.019).
• Improvement in headache/ICP-related symptoms was seen in 90.9% of EEA patients versus 76.5% of TCA patients (p=0.047).
• Objective visual outcomes were better after EEA (BCVA: 0.30 vs. 0.42, p=0.041).
• EEA had lower rates of electrolyte imbalance (17.6% vs. 42.4%, p=0.021) and transient diabetes insipidus (20.6% vs. 45.5%, p=0.028).
• Recurrence/progression at last follow-up was lower in EEA patients (8.8% vs. 21.2%, p=0.047).

Interpretation:

EEA was associated with better outcomes in terms of GTR, hospitalization duration, and fewer complications compared to TCA.

Limitations:

• The study is observational and unadjusted, making it susceptible to confounding by indication, which may affect the validity of the findings.
• Results are based on a single-center experience, which may limit generalizability.

Conclusion:

EEA is associated with improved surgical outcomes for craniopharyngioma resection.