Craniopharyngiomas are rare tumors with peak incidence between 5–14 and between 65–74 years of age. Treatment of choice is surgical resection, sometimes associated with radiation therapy. Complete tumor resection may be challenging. Radical surgery is particularly risky in older patients. Authors evaluate three cases of large cystic craniopharyngioma in patients in their 7th and 8th decade of life operated with the use of endoscopic technique. The postoperative follow-up period in which out-patient controls with imaging examinations were performed was up to 6 years. Symptoms of intracranial hypertension resolved in all patients in the immediate postoperative period. Visual acuity improved in two patients. No cases of aseptic meningitis have been reported. One patient underwent subsequent radio-therapy. The well-being of the operated patients continued.
Endoscopic transventricular approach to cystic craniopharyngiomas may be a safe and effective approach in older patients, being an alternative to microsurgical procedures.

I n t r o d u c t i o n: Complications occurring aft er neurosurgical procedures which lead to reoperations are associated with poor treatment outcomes. Th e aim of our study was to establish predictive factors of unplanned early reoperations aft er intracranial meningioma removal.

Ma t e r i a l s a n d M e t h o d s: We retrospectively analyzed 177 patients who underwent craniotomy due to an intracranial meningioma. Early reoperation was defi ned as reoperation during the same hospital stay. We used a χ2 test for proportional values and t-test and Mann-Whitney U tests as appropriate for continuous variables. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses.

R e s u l t s: A total of 13 (7.34%) patients underwent unplanned early reoperation. Th ese patients underwent retrosigmoid craniotomies (25.00% vs. 6.40%; p = 0.047), suff ered from ischemic heart disease (66.67% vs. 6.64%; p <0.01) and atrial fi brillation (60.00% vs. 6.25%; p <0.01), were receiving heparin (50.00% vs. 6.74%; p <0.01) and anticoagulants (66.67% vs. 6.21%; p <0.01) signifi cantly more oft en than the general study population. In multivariate logistic regression analysis anticoagulant use (OR: 31.463; 95% CI: 1.139–868.604; p = 0.04) and retrosigmoid craniotomy (OR: 6.642; 95% CI: 1.139–38.73; p = 0.034) remained independently associated with a higher risk of early reoperation.

C o n c l u s i o n s: Patients who underwent retrosigmoid craniotomy, those with a history of ischemic heart disease or atrial fi brillation and those who take heparin or anticoagulants are more likely to require early reoperation. Retrosigmoid craniotomy and anticoagulant use are independent risk factors for early reoperation.