4K 3D orbital camera (Orbeye, Olympus) is a novel exoscopic system, which was described for skull base transsphenoidal operations, however structured analyses regarding application for craniopharyngioma resection are lacking. The aim of this study was to assess the utility of exoscopic transsphenoidal surgery (ExTS) and compare it to well established microscopic transsphenoidal surgery (MTS).
Patients with confirmed histological diagnosis of craniopharyngioma and operated between 2013-2022 were enrolled into our retrospective monocentric study. Data regarding duration of surgery, length of hospital stay, recurrence rate, extent of resection and postoperative complications (diabetes insipidus, SIADH, anterior pituitary insufficiency, CSF-leak, meningitis, nonobstructive hydrocephalus) were assessed.
A total number of 102 patients, who underwent 122 operations were included. Mean(±SD) duration of surgery in minutes was significantly shorter for repeated ExTS (144(±50.5) minutes vs. 121.3(±50.2) minutes, p=0.028). Mean length of hospital stay was significantly shorter after ExTS comparing to MTS for repeated surgeries (6.9 days vs. 5.6 days, p=0.048). The incidence of postoperative complications like CSF-leak (11.3% vs. 9.5%, p>0.99), diabetes insipidus (25% vs. 23.8%, p=0.83), SIADH (2.5% vs. 2.4%, p>0.99), new pituitary insufficiency (38.8% vs. 35.7%, p=0.84), meningitis (2.5% vs. 0%, p=0.55), nonobstructive hydrocephalus (2.5% vs. 2.4%, p>0.99) was not significantly different between both groups. Recurrence rate was 36% and 25% (p=0.28) for MTS and ExTS respectively. Gross total resection rate was higher for MTS, however without statistical significance (47.5% vs. 40.5%, p=0.25).
Our study confirmed the utility of ExTS for craniopharyngioma resection, as it revealed no statistically significant differences regarding complication rates, recurrence rate along with mean duration of surgery and mean length of postoperative stay for both all and first surgeries comparing to MTS. Moreover the mean duration of surgery and mean length of postoperative stay after repeated ExTS were significantly shorter than by MTS reoperations.