Clinical Outcome After Extended Endoscopic Endonasal Resection of Craniopharyngiomas: Two-Institution Experience

Park, Hye Ran; Kshettry, Varun R.; Farrell, Christopher; Lee, Jae Meen; Kim, Yong Hwy; Won, Tae Bin; Han, Doo Hee; Do, Hyunwoo; Nyguist, Gurston; Rosen, Marc; Kim, Dong Gyu; Evans, James J.; Paek, Sun Ha

doi:10.1016/j.wneu.2017.04.047

Cited by 59 publications

(40 citation statements)

References 28 publications

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“…Post-operative morbidity after GTR, STR, or STR combined with adjuvant radiation therapy included: endocrine dysfunction (55% AE 5.8%, 48.9% AE 9.1%, 52.4% AE 7.7% respectively), diabetes insipidus (29% AE 18.6%, 19.5% AE 7%, 9.7% AE 4.6% respectively), obesity (6%, 0%, 4% respectively), panhypopituitarism (22% AE 30.1%, 16.1% AE 12.5%, 26.4% AE 2% respectively), visual dysfunction (8.5% AE 7.3%, 18% AE 19.2%, 12.7% AE 5.6% respectively), and neurologic dysfunction (11%, 11%, 0% respectively) ( Table 2). 6,20,24,27…”

Section: Resultsmentioning

confidence: 99%

“…15 Multiple other studies have corroborated this finding, demonstrating that the addition of RT to STR reduced recurrence rates to 14–37.5%, which is comparable to the recurrence rates achieved after GTR in multiple series. 6,12,16,18,20,21,24…”

Section: Discussionmentioning

confidence: 99%

“…27 STR+RT reduced the incidence of most of these complications, and significantly reduced the incidence of post-operative DI to 4% (Table 2). 6,20,24,27…”

Section: Discussionmentioning

confidence: 99%

“…8 This is evident in multiple case series in which recurrence rates range from 24.8-100% after performing STR, as compared to recurrence rates ranging from 0-52.1%% after GTR (Table 1, follow-up 2.2-10 years). 6,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] In 1996 Eldevik et al examined only CP patients who underwent STR and reported that the addition of radiation reduced recurrence from 85.6% to 35%. 15 Multiple other studies have corroborated this finding, demonstrating that the addition of RT to STR reduced recurrence rates to 14-37.5%, which is comparable to the recurrence rates achieved after GTR in multiple series.…”

Section: Gtr Versus Str Recurrence Ratesmentioning

confidence: 99%

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Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas

Grewal

Spielman

Safi

et al. 2020

Allergy�Rhinol (Providence)

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Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient’s individual tumor characteristics, risk, symptoms, and therapeutic goals.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…27 STR+RT reduced the incidence of most of these complications, and significantly reduced the incidence of post-operative DI to 4% (Table 2). 6,20,24,27…”

Section: Discussionmentioning

confidence: 99%

Section: Gtr Versus Str Recurrence Ratesmentioning

confidence: 99%

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Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas

Grewal

Spielman

Safi

et al. 2020

Allergy�Rhinol (Providence)

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“…3,12,38,63,91,97 CSF leak rates with ESBS in more recent large series in which nasal septal flap closure was used are now 2.9%-5.2%, much lower than in previous reports. 12,67 Furthermore, improving exposure techniques and cadaveric studies have expanded the utility of this approach even for large and difficult tumors in adults and children. 1,16 Recent studies have demonstrated that large tumors, those in difficult locations with limited surgical corridors, and even recurrent tumors can be safely and effectively resected using ESBS.…”

Section: Data From 2012 To 2017mentioning

confidence: 99%

Lessons learned in the evolution of endoscopic skull base surgery

Schwartz

Morgenstern²,

Anand

2019

Journal of Neurosurgery

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OBJECTIVEEndoscopic skull base surgery (ESBS) is a relatively recent addition to the neurosurgical armamentarium. As with many new approaches, there has been significant controversy regarding its value compared with more traditional approaches to ventral skull base pathology. Although early enthusiasm for new approaches that appear less invasive is usually high, these new techniques require rigorous study to ensure that widespread implementation is in the best interest of patients.METHODSThe authors compared surgical results for ESBS with transcranial surgery (TCS) for several different pathologies over two different time periods (prior to 2012 and 2012–2017) to see how results have evolved over time. Pathologies examined were craniopharyngioma, anterior skull base meningioma, esthesioneuroblastoma, chordoma, and chondrosarcoma.RESULTSESBS offers clear advantages over TCS for most craniopharyngiomas and chordomas. For well-selected cases of planum sphenoidale and tuberculum sellae meningiomas, ESBS has similar rates of resection with higher rates of visual improvement, and more recent results with lower CSF leaks make the complication rates similar between the two approaches. TCS offers a higher rate of resection with fewer complications for olfactory groove meningiomas. ESBS is preferred for lower-grade esthesioneuroblastomas, but higher-grade tumors often still require a craniofacial approach. There are few data on chondrosarcomas, but early results show that ESBS appears to offer clear advantages for minimizing morbidity with similar rates of resection, as long as surgeons are familiar with more complex inferolateral approaches.CONCLUSIONSESBS is maturing into a well-established approach that is clearly in the patients’ best interest when applied by experienced surgeons for appropriate pathology. Ongoing critical reevaluation of outcomes is essential for ensuring optimal results.

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