Benefits and limitations of a dual faculty neurosurgeon approach to resection of pediatric craniopharyngioma

Abstract

The utility and safety of including two neurosurgeons for tumor resections is unknown. This study compares outcomes among pediatric patients with craniopharyngiomas operated on with a dual or single surgeon approach (DSA, SSA). Methods:A single-center review identi ed all craniopharyngioma transsphenoidal or craniotomy resections from 2000-2020. Surgical years of experience (YOE) and rates of 5-year reoperations, complications, recurrence, postoperative radiotherapy were analyzed. Results:26 transsphenoidal and 68 craniotomies were identi ed among 62 patients. Eleven transsphenoidal (42.3%) utilized DSA and 15 utilized (57.7%) SSA. Eight craniotomies (11.8%) were DSA and 60 (88.2%) were SSA.The surgeon for SSA transsphenoidal procedures had a median of 10.7 YOE (IQR: 9.9-13.7) versus 6.6 (IQR: 2.7-16; p = 0.058) for the lead surgeon in DSAs. The co-surgeon in transsphenoidal DSAs had a median of 27 YOE (IQR: 11.8-35.7).The surgeon for SSA craniotomies had a median of 19.3 YOE (IQR: 12.1-26.4) versus 4.5 years (IQR: 1.3-15.3; p = 0.017) for the lead surgeon in DSA cases. The co-surgeon in DSA craniotomies had a median of 23.2 YOE (IQR: 12.6-31.4).Case complexity was similar across transsphenoidal groups. DSA transsphenoidal resections had fewer complications (18% DSA vs. 33% SSA), reoperations (45% vs. 53%), and radiation therapy (9.1% DSA vs. 33% SSA) than SSA. Conclusion:Lead surgeons in DSAs are frequently junior surgeons while SSAs typically employ senior surgeons. Outcomes did not signi cantly differ between DSA and SSA, but there was a trend towards improved outcomes for DSA transsphenoidal cases. Mentorship through DSAs does not seem to negatively affect patient care.Case complexity and surgeon experience (Table 1