• Xiang'en Shi, Zhongqing Zhou, Bin Wu, Yongli Zhang, Hai Qian, Yuming Sun, Yang Yang, Zaitao Yu, Zhiwei Tang, and Shuaibin Lu.
• Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China. Electronic address: shixen@sina.com.
• World Neurosurg. 2017 Jun 1; 102: 167-180.

ObjectiveA retrospective review of the surgical outcome for patients with craniopharyngioma (CP) treated in a single neurosurgical center with surgical resection using visualization to ensure hypothalamic preservation.MethodsThe study included 1054 patients. Before 2003, a pterional cranial approach was preferred for 78% of patients; after 2004, the unifrontal basal interhemispheric approach was performed in 79.1% of patients.ResultsComplete tumor resection was achieved in 89.6% of patients; vision improved in 47.1% of patients who had preoperative vision impairment. However, diabetes insipidus worsened in 70.4% of patients and new-onset diabetes insipidus occurred in 29.7% of the remaining patients. Pituitary stalk preservation occurred in 48.9% of cases. There were 89.6% of patients with total tumor removal; 13.3% of patients showed tumor recurrence within an average of 2.8 years. Of 69 follow-up patients with a subtotal or partial resection, 94.2% showed tumor recurrence within an average of 4.3 months. Of the total patients, 82.3% fully recovered.ConclusionsThis study has shown that radical surgical resection of CP using microsurgical excision can be effective with a good patient outcome without more limitations on each individual tumor of distinct features despite the impact of recent endoscopic techniques on CP surgery. The surgical approach depends on a direct and wider visualization of CP located in the midline with preserving hypothalamic structures by identifying some hypothalamic landmark structures. After surgery, most patients can resume their normal activities even after aggressive tumor removal, although patients require postoperative hormonal replacement.Copyright © 2017 Elsevier Inc. All rights reserved.

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