Outcomes of endoscopic endonasal surgery for pediatric craniopharyngioma with a focus on morphological preservation of the pituitary stalk and endocrine functions.

Purpose: Preservation of endocrine function in pediatric patients with craniopharyngioma is crucial. However, few reports of endoscopic endonasal surgery (EES) for pediatric craniopharyngiomas with intending endocrine function preservation exist. This study aimed to identify the outcomes of EES with intending preservation of pituitary stalk in pediatric patients with craniopharyngioma.

Methods: Data from 22 pediatric patients with craniopharyngioma who underwent 35 EESs between 2011 and 2022 were retrospectively assessed. The tumor location (infradiaphragmatic [ID] or supradiaphragmatic [SD]) and endocrine functions were evaluated. The patients were divided into two groups: those with preoperatively preserved some endocrine function (Group P) and already completely lost endocrine function (Group ACL). Morphological preservation of the pituitary stalk (MPPS) and postoperative endocrine functional outcomes were analyzed only in the cases of Group P. Tumor recurrence was evaluated in all patients.

Results: In the 35 EESs, the tumors were ID in 17 cases and SD in 18. Twenty-five cases were included in Group P and 10 in Group ACL. In Group P, MPPS was achieved in 18 (72%) cases, and postoperative preservation of some endocrine function was achieved in 14 (77.8%) of the MPPS cases. ID tumor (P < 0.001) and intraoperative MPPS (P < 0.001) were associated with postoperative preservation of some endocrine function. Intraoperative MPPS (P = 0.044) was a significantly associated risk factor for tumor recurrence.

Conclusions: In EES for pediatric craniopharyngiomas, postoperative preservation of some endocrine function is achievable in ID tumors with MPPS. Therefore, preservation of endocrine function should be attempted in cases of ID tumors. However, clinicians should be aware that MPPS increases the risk of tumor recurrence.