Abstract: Objective To evaluate the efficacy and safety of neuroendoscopic extended transnasal approach for selected craniopharyngiomas. Methods The clinical data of 16 patients underwent neuroendoscopic extended transnasal resection of craniopharyngiomas from June 2015 to December 2019 were analyzed retrospectively. Results All the tumors were removed under direct visualization. Gross-total resection was performed in 14 patients (accounting for 87.5%) and subtotal-resection in 2 patients (accounting for 12.5%). Among the 12 patients with preoperative visual impairment, the postoperative visual acuity improved in 10 patients (accounting for 83.3%) and remained unchanged in 2 patients (accounting for 16.7%). Postoperative hypopituitarism occurred in 9 cases (accounting for 56.3%) , diabetes insipidus occurred in 6 cases (accounting for 37.5%).  There were 4 cases (accounting for 25%) of hyposmia, 2 cases of CSF leakage (accounting for 12.5%) and 2 cases of obesity (accounting for 12.5%), and 1 case of meningitis (accounting for 6.3%), 1 case of hydrocephalus (accounting for 6.3%) and 1 case of memory deterioration (accounting for 6.3%) occurred postoperatively. There were tumor no recurrence after 2-59 months follow- up . Conclusions The surgical resection of craniopharyngiomas by extended neuroendoscopic transnasal approach has the advantages of excellent direct visualization of the tumors, high total resection rate and high visual improvement. CSF leakage and hyposmia were the major disadvantages of this approach, so the reconstruction of skull base and the protection of nasal mucosa should be paid more attention  during the surgery.

Key words: Neuroendoscopy, 　Extended transnasal approach, 　Craniopharyngiomas