Minimally Invasive Cyst Drainage for Cystic Craniopharyngioma: Neuroendoscopic Fenestration or Stereotactic Cyst Drainage?

Abstract

The prognosis and optimal surgical techniques of minimally invasive cyst drainage (MICD) for cystic craniopharyngioma are poorly defined. The aim of this study was to evaluate the effect of neuroendoscopic fenestration versus stereotactic cyst drainage for cystic craniopharyngioma, based on 2 observational cohorts. We conducted a retrospective analysis of prospectively collected clinical data from 39 craniopharyngioma patients treated with MICD between January 2015 and February 2025 at 2 neurosurgical centers in the same institution. All patients underwent either neuroendoscopic fenestration (n = 21) or stereotactic cyst drainage (n = 18), with Ommaya reservoir system placement for potential cyst recurrence management. The primary outcome was tumor recurrence/progression, assessed through survival analysis using the Kaplan-Meier method, with prognostic factors identified via proportional hazards modeling. Secondary outcomes included visual and endocrine function results and surgical complications. The distribution of preoperative clinical and tumor-related data was balanced between the 2 cohorts. In the entire mixed cohort, at a median follow-up of 40 months, tumor progression occurred in 48.7% of the patients. The neuroendoscopic group had lower progression than in the stereotactic group (38.1% vs. 61.1%). Neuroendoscopy achieved a greater reduction in postoperative cyst volume (P = 0.011); the neuroendoscopic group had longer progression-free survival (median progression-free survival: 66 months vs. 41 months, P = 0.064) and needed fewer therapeutic interventions than the stereotactic group. No patient suffered obvious visual functional decline, and the risk of endocrine deterioration was similarly low in both groups (P = 0.341). In addition, neuroendoscopy was associated with fewer surgical complications. MICD is associated with low surgical morbidity and a relatively high cyst recurrence rate. Neuroendoscopic fenestration shows potential in delaying tumor progression and reducing the need for late interventions.