Endoscopic and Microscopic Transsphenoidal Surgery of Craniopharyngiomas: A Systematic Review of Surgical Outcomes Over Two Decades

Zoli, Matteo; Mazzatenta, Diego; Gompel, Jamie J. Van

doi:10.1055/s-0037-1607195

Cited by 16 publications

(7 citation statements)

References 64 publications

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“…In the stratified analysis, the EEA did not show any significant difference in the adult (OR = 1.84, 95% CI 0.41-8.16, p = 0.424) and mixed (OR = 2.45, 95% CI 0.87-6.87, p = 0.066) groups for achieving a higher GTR rate as compared with TCA. Generally, although a higher GTR rate was commonly considered as an advantage of the EEA by most published researchers, the results from our study and those of several recent studies did not support this superiority, suggesting that the possibility of the surgical technique of the TCA in neurosurgeons might have improved along with the development of other surgical techniques [11,40]. Moreover, Younus et al confirmed that the higher GTR rate was significantly achieved by senior specialists than surgeons with limited clinical practice (71% vs. 47%, p < 0.05), suggesting that the GTR rate in EEA might increase as neurosurgeons improve their surgical process using the EEA in the next decade [41].…”

Section: Publication Biascontrasting

confidence: 94%

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

Li,

Ye,

Nie

et al. 2024

World J Surg Onc

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Background Craniopharyngiomas (CPs) are generally derived from the craniopharyngeal duct epithelium, accounting for 38% and 24.5% of mortality in pediatric and adult patients, respectively. At present, the widespread application of the endoscopic endonasal transsphenoidal approach (EEA) has led to controversy between the traditional microscopic transcranial approach (TCA) and EEA in relation to the surgical management of CPs. Object and method We performed a systematic review and meta-analysis comparing the complications, surgical outcomes, and endocrine functions of patients with CPs to provide evidence-based decision-making in their surgical management. Result Overall, 11 observational studies with 12,212 participants were included in the meta-analysis, in which five of them only included an adult population, three of them only included a child population, and the other three studies included a mixed population (adult and child). In pediatric patients, the EEA achieved a higher gross total resection (GTR) rate (odds ratio (OR) = 5.25, 95%CI: 1.21–22.74), lower recurrence rate (OR = 0.54, 95%CI: 0.31–0.94, p = 0.030), and less hypopituitarism (OR = 0.34, 95%CI: 0.12–0.97, p = 0.043). In adult patients, EEA significantly improved mortality (OR = 0.09, 95%CI: 0.06–0.15, p < 0.001) and visual outcomes (visual improvement: OR = 3.42, 95%CI: 1.24–9.40, p = 0.017; visual deficit: OR = 0.30, 95%CI: 0.26–0.35) with decreases in postoperative stroke (OR = 0.58, 95%CI: 0.51–0.66, p < 0.001), hydrocephalus, and infections (OR = 0.32, 95%CI: 0.24–0.42, p < 0.001). Conclusion Compared with the traditional TCA in primary CP resection, the development and wide application of EEA optimistically decreased the recurrence rate of CP, alleviated hypopituitarism with improvement in the GTR rate of pediatric patients, and significantly improved the visual outcomes, hydrocephalus, postoperative stroke, survival, and infection rates of the patients. Therefore, EEA is an optimal approach for primary CP resection.

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Section: Publication Biascontrasting

confidence: 94%

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

Li,

Ye,

Nie

et al. 2024

World J Surg Onc

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“…27 A recent meta-analysis found 67.8% GTR and 21% recurrence for endoscopic endonasal CP resections. 5 However, irregular and jagged tumor borders, often large size, and adhesion to nearby structures make surgery particularly difficult, making safe GTR impossible. 28 Postoperative visual deterioration ranges between 0% and 33%.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Gross total resection (GTR) significantly reduces recurrence; however, recently, several centers have opted for subtotal resection followed by adjuvant RT to reduce postoperative sequelae. 4-9 Conventional RT has been the primary treatment for residual/recurrent CPs for decades, but it can cause collateral hypothalamic, pituitary, and ocular damage, especially in young patients. Stereotactic radiosurgery (SRS) permits precise irradiation, thus minimizing unnecessary radiation exposure; however, large volume and neighboring organ at risks (OARs) limit single-fraction SRS.…”

mentioning

confidence: 99%

Frameless Hypofractionated Gamma Knife Radiosurgery for Residual or Recurrent Craniopharyngioma

Samancı

Essibayi²,

Askeroglu³

et al. 2023

Neurosurgery

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BACKGROUND:The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. Gamma Knife radiosurgery (GKRS) is an essential technique for residual/recurrent craniopharyngiomas. OBJECTIVE: To evaluate the efficacy of frameless hypofractionated GKRS (hfGKRS) for craniopharyngioma and factors which affect tumor control and complications. METHODS: This retrospective study involved 24 patients managed with hfGKRS. Clinical and radiological data, tumor characteristics, and procedural details were analyzed. RESULTS: There were 15 (62.5%) female patients. The median age was 38.5 years (range, 3-66 years). The mean tumor volume was 2.4 (1.93) cm 3 , with a mean solid volume of 1.6 (1.75) cm 3 . The median marginal dose was 20 Gy (range, 18-25 Gy) delivered in a median of 5 fractions (range, 3-5). During a median radiological follow-up of 23.5 months (range, 12-50 months), tumor progression was noted in 5 (20.8%) patients. The 2-year and 4-year progression-free survival were 81.8% and 61.4%, respectively. No deaths were identified at a median clinical follow-up of 31.3 months (range, 12-54 months). Visual deficits attributable to progression were noted in 3 (12.5%) patients with pre-GKRS visual field defects. An additional 4 (16.7%) patients with pre-GKRS visual deficit developed new minor visual field defects. Four (16.7%) patients showed improvement of vision after GKRS. There were no new-onset post-GKRS hormonal deficits. CONCLUSION: The management of craniopharyngioma requires a multidisciplinary approach, and irradiation represents effective treatment option for residual/recurrent tumors after surgery. To the best of our knowledge, this is the first study that addresses the efficacy of frameless hfGKRS in managing craniopharyngiomas over sufficient follow-up.

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“…Hydrocephalus was among the least frequent complications for both surgical approaches; some authors were more concerned about hydrocephalus as a pre-existing condition than a surgical complication [ 44 ]. However, Cagnazzo et al presented results suggesting hydrocephalus was more common after the transsphenoidal endoscopic procedure [ 45 ]. Komotar et al also showed that EEA carried a higher incidence for this complication, at 15.80% compared to 10.10% for TCA.…”

Section: Discussionmentioning

confidence: 99%

Current Role of Endoscopic Endonasal Approach for Craniopharyngiomas: A 10-Year Systematic Review and Meta-Analysis Comparison with the Open Transcranial Approach

Figueredo,

Martínez,

Suarez-Meade

et al. 2023

Brain Sciences

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In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal–Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person’s characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.

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Endoscopic and Microscopic Transsphenoidal Surgery of Craniopharyngiomas: A Systematic Review of Surgical Outcomes Over Two Decades

Abstract: Both techniques appear comparable for infradiaphragmatic lesions; however, TE seems to yield better results for supradiaphragmatic tumors. In conclusion, more complex lesions with difficult locations can be effectively treated with endoscopic surgery.

Cited by 16 publications

References 64 publications

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

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

Frameless Hypofractionated Gamma Knife Radiosurgery for Residual or Recurrent Craniopharyngioma

Current Role of Endoscopic Endonasal Approach for Craniopharyngiomas: A 10-Year Systematic Review and Meta-Analysis Comparison with the Open Transcranial Approach

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