Characteristics and Outcomes in Pediatric Versus Adult Craniopharyngiomas: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Craniopharyngiomas account for 1.2% to 4.6% of all intracranial tumors. Although age at presentation is distributed bimodally, with a pediatric peak occurring between 5 and 15 years and an adult peak between 50 and 70 years, presentation, treatment, and outcome differences between these two craniopharyngioma populations have not been thoroughly characterized. OBJECTIVE: To compare treatments and outcomes between adult and pediatric craniopharyngiomas. METHODS: This is a systematic review and meta-analysis. Web of Science, MEDLINE, and Scopus databases were searched for primary studies reporting postoperative complications, functional outcomes, recurrence, and overall survival in patients with craniopharyngioma undergoing surgery. RESULTS: The search yielded 1,202 unique articles, of which 106 (n=4,202 patients) met criteria for qualitative synthesis and 23 (n=735 patients) met criteria for meta-analysis. Compared with adult, pediatric craniopharyngiomas were less likely to present with visual defects (odds ratio [OR] 0.54, 95% CI 0.36-0.80) or cognitive impairment (OR 0.29, 95% CI 0.12-0.71) and more likely with headaches (OR 2.08, 95% CI 1.16-3.73). Children presented with significantly larger tumors compared with adults (standardized mean difference 0.68, 95% CI 0.38-0.97). Comparing functional outcomes, pediatric patients sustained higher rates of permanent diabetes insipidus (OR 1.70, 95% CI 1.13-2.56), obesity (OR 3.15, 95% CI 1.19-8.31), and cranial nerve and/or neurological defects (OR 4.87,) than adults. No significant differences were found in rates of postoperative cerebrospinal fluid leak, overall or progression-free survival, or recurrence. CONCLUSION: Adult and pediatric craniopharyngiomas seem to have fundamental differences in clinical presentation and functional outcomes. These patients frequently require multimodality treatment and are best managed with a multidisciplinary team and an individualized approach.

Endoscopic endonasal transsphenoidal approach improves endocrine function and surgical outcome in primary craniopharyngioma resection: a systematic review and meta-analysis

“…These results strongly support the recommendation of the EEA based on its superiority in GTR and avoiding recurrence in primary CP resection. However, unlike the findings of a previous meta-analysis, the stratified analysis in this study significantly supported the superiority of the EEA in the child population (OR = 0.15, p = 0.007) [8,12]. Notably, contrary to our study (OR = 1.84, p = 0.424), a previous meta-analysis reported a significant superiority of the EEA in GTR in the adult population [44].…”

“…At present, only a few meta-analyses comparing the EEA and TCA were published, which were limited to mixing adults and pediatric patients or synthesizing effect size of single proportions rather than dichotomous outcomes [8,[11][12][13][14][15][16]. It is well-accepted that there is a limitation of the methodology of statistical analysis in single-proportion meta-analysis, because a single-proportion meta-analysis commonly ignores the heterogeneity of the included study when pooling proportions and drawing conclusions, which might lead to a lack of interpretability and misleading conclusions [17][18][19].…”

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

“…Of those, only 7% had an actual CSF leak, with an overall positive predictive value of 7.6%. 3 Therefore, history alone is generally not a reliable indicator for CSF rhinorrhea and is usually combined with other diagnostic modalities to clench the diagnosis.…”

“…Moreover, symptoms such as headaches may be nonspecific and are of limited diagnostic value. 3 The diagnosis may be missed entirely and confused with common conditions, such as allergic rhinitis. Even when CSF leak is on the differential, the fluid can be present alongside blood or mucus, complicating physical exam and contributing to false negatives on laboratory testing.…”

“…The condition can be subtle because rhinorrhea is incredibly common in the general population. Moreover, symptoms such as headaches may be nonspecific and are of limited diagnostic value 3 . The diagnosis may be missed entirely and confused with common conditions, such as allergic rhinitis.…”