The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery

Purpose Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that vascular compromise of the primary superior hypophyseal artery (pSHA) may be related to this occurrence. Methods We performed a retrospective review of 131 patients with craniopharyngioma who underwent endoscopic transsphenoidal surgery from April 2009 to September 2021. Initial surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk were included. Data on the age, sex, maximum tumor diameter, Kassam type and tumor resection rate of the included patients were obtained from their medical records. The branches of the pSHA are divided mainly into chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. Results Twenty of the 131 patients met the criteria. The preoperative anterior pituitary functions were normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). The postoperative anterior pituitary function was unchanged in eight patients. Permanent DI did not occur in 15 patients. Bilateral preservation of the pSHA Ib was the only associated factor for maintaining anterior pituitary function. In contrast, the preservation of any pSHA branch yielded no significant difference in postoperative permanent DI. Conclusions In craniopharyngioma surgery, bilateral preservation of the pSHA Ib provides favorable postoperative anterior pituitary function; however, such preservation may have little effect on postoperative DI occurrence.