Role of Diaphragma Sellae Resection in Endoscopic Endonasal Surgery for Craniopharyngioma

Endoscopic endonasal surgery craniopharyngioma management has evolved significantly as a primary treatment for infradiaphragmatic lesions. These tumors are anatomically distinct, often bounded by an elevated diaphragma sellae (DS). However, achieving complete tumor removal remains a formidable challenge due to frequent adhesions between the tumor and the DS. A recent retrospective study evaluated whether diaphragma sellae resection (DSR) improves surgical efficacy or increases postoperative risks. The results provide critical insights for neurosurgeons managing these complex pathologies.

Clinical Impact of Endoscopic Endonasal Surgery Craniopharyngioma Outcomes

The research cohort included forty-six patients, with twenty-nine undergoing DSR and seventeen in the non-DSR group. Notably, patients in the DSR group frequently presented with larger tumor volumes and significant preoperative endocrine dysfunction. While the overall extent of tumor resection did not differ between the two groups, DSR significantly increased the rate of pituitary stalk transection. Consequently, this maneuver often results in permanent hormonal changes that require lifelong management. Furthermore, surgeons noted that performing DSR led to longer operation times compared to the non-resection approach.

Most importantly, the study highlighted a clear oncological benefit regarding long-term disease control. Specifically, the recurrence rate was significantly lower in the DSR group compared to the non-DSR group. Although visual outcomes and hypothalamic involvement remained comparable postoperatively, the reduction in recurrence suggests that DSR effectively addresses microscopic tumor invasion within the diaphragma. Therefore, clinicians must carefully balance the trade-off between the increased risk of endocrine deficits and the superior control of tumor regrowth. Additionally, the study confirms that EES remains a safe and effective corridor for treating these lesions when performed by experienced teams.

FAQs on Endoscopic Endonasal Surgery Craniopharyngioma

Does resection of the diaphragma sellae increase the risk of hormone deficiency?

Yes, clinical data indicates that DSR significantly correlates with a higher rate of pituitary stalk transection. This surgical step often leads to permanent endocrine dysfunction, making long-term hormone replacement therapy necessary for most patients.

What is the primary benefit of DSR in these surgeries?

The most significant advantage of DSR is the reduction in tumor recurrence rates. By removing the diaphragma sellae, which may contain adherent or invasive tumor cells, surgeons achieve more durable long-term control of the craniopharyngioma.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Professional medical advice should always be sought for any health-related concerns. Refer to the latest local and national guidelines for clinical practice.

References

Wu J et al. Endoscopic endonasal surgery for infradiaphragmatic craniopharyngiomas: the impact of diaphragma sellae resection. J Neurosurg. 2026 Feb 20. doi: 10.3171/2025.10.JNS251780. PMID: 41719552.

Gomez-Amador JL, et al. Endoscopic endonasal approach for craniopharyngiomas. Neurosurg Clin N Am. 2020;31(4):531-544.

National Cancer Institute. Craniopharyngioma Treatment (PDQ®)–Health Professional Version. Updated 2024.