Endoscopic Endonasal Compared with Microscopic Transsphenoidal and Open Transcranial Resection of Craniopharyngiomas

Komotar, Ricardo J.; Starke, Robert M.; Raper, Daniel; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.1016/j.wneu.2011.07.011

Cited by 230 publications

(234 citation statements)

References 87 publications

Supporting

Mentioning

206

Contrasting

Order By: Relevance

“…9 Treatment in the form of surgery, radiation, or both, has been implicated in further deterioration. 9,24,32 In assessing a patient's response to therapy, these traditional surgical end points, however, only tell a portion of the story. In addition to survival, progression-free survival, and morbidity, a patient's QOL is becoming increasingly important in assessment of therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Endonasal endoscopic transsphenoidal resection of craniopharyngiomas, compared with open transcranial approaches, has been shown to result in comparable or even greater rates of extent of resection and GTR. 3,5,11,13,21,24,27 Moreover, rates of visual improvement may in fact be higher. 24 Nevertheless, debate regarding the relative merits of endonasal endoscopic surgery compared with open transcranial approaches continues.…”

Section: Discussionmentioning

confidence: 99%

“…22,27 An endoscopic transsphenoidal approach offers a more direct route to the tumor, avoiding brain retraction, minimizing manipulation of the optic nerves and adjacent small perforating vessels, and resulting in equally high gross-total resection (GTR) rates compared with transcranial series, as well as potentially better visual results. 3,5,11,13,21,24,27 Although there are increasing data about the oncological, neurological, and hormonal outcomes for this treatment option, there are no studies assessing postoperative QOL. In an effort to gain a better understanding of the impact of an endoscopic approach in the treatment of craniopharyngiomas, we used accepted site-specific QOL metrics to measure postoperative QOL in a series of patients with craniopharyngiomas by using their own preoperative data as an internal control in a subset of patients, as well as data from a separate group who underwent endonasal endoscopic pituitary surgery, to control for the approach and highlight disease-specific morbidity.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Patel

Raza

McCoul³

et al. 2015

JNS

Self Cite

View full text Add to dashboard Cite

T he management of craniopharyngiomas is fraught with challenges that not only hinder achievement of optimal oncological outcomes but potentially have adverse effects on the quality of life (QOL). At time of presentation, and certainly after treatment, craniopharyngiomas can be associated with visual field defects, endocrinopathies, hypothalamic syndromes, increased cardiovascular risk, and neurocognitive sequelae. 7,9,33,37,46 Although considered benign tumors, their location can impact critical structures such as the optic nerves and chiasm, hypoabbreviatioNs ASBQ = Anterior Skull Base Quality of Life; BMI = body mass index; GTR = gross-total resection; QOL = quality of life; obJect Craniopharyngiomas are benign parasellar tumors for which surgical removal, although potentially curative, often leads to morbidity with resulting decreases in quality of life (QOL). The endonasal endoscopic approach is a minimal-access technique for removing these tumors and may reduce postoperative morbidity. The QOL following this method for resection of craniopharyngiomas has not been documented. methods The authors reviewed a database of consecutive endonasal endoscopic surgeries done at Weill Cornell Medical College. Adult patients with histologically proven craniopharyngiomas were included who had completed either only postoperative (> 9 months) or both pre- and postoperative QOL forms, the Anterior Skull Base Quality of Life (ASBQ) questionnaire, and the 22-Item Sinonasal Outcome Test (SNOT-22). Rates of gross-total resection (GTR), complications, and visual and endocrine function were collected. Retrospective independence (Wen score) was also assigned. A contemporaneous group of patients undergoing endonasal endoscopic pituitary macroadenoma resection was used as a control. results This study included 33 procedures performed in 31 patients. The average postoperative ASBQ score was 3.35 and the SNOT-22 score was 19.6. Better QOL was associated with GTR and postoperative radiation. Worse QOL was associated with persistent visual defects, hypopituitarism, tumor recurrence, increase in body mass index, and worsening Wen score. In a subset of 10 patients, both pre- and postoperative (> 9 months) QOL scores were obtained. Both ASBQ and SNOT-22 scores showed stability and a trend toward improvement, from 2.93 ± 0.51 to 2.96 ± 0.47 (ASBQ) and . Compared with 62 patients undergoing endoscopic pituitary macroadenoma resection, patients with craniopharyngiomas had worse postoperative QOL on the ASBQ (3.35 vs 3.80; p = 0.023) and p = 0.12). coNclusioNs This report of validated site-specific QOL following endoscopic surgery for craniopharyngiomas shows an overall maintenance of postoperative compared with preoperative QOL. Better QOL could be seen in patients with GTR and radiation therapy, and worse QOL was found in patients with visual or endocrine deficits. Nevertheless, patients with craniopharyngiomas still had worse QOL than those undergoing similar surgery for pituitary macroadenomas, confirming the worse prognosis of craniop...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Patel

Raza

McCoul³

et al. 2015

JNS

Self Cite

View full text Add to dashboard Cite

show abstract

“…They reported favorable ophthalmologic and endocrine outcomes as well, with a low complication rate. Komotar et al [ 85 ] performed a meta-analysis to compare the extended endoscopic and open techniques for craniophary ngioma removal using 88 studies published between 1995 and 2010. Overall, they found higher rates of both GTR (66.9% vs. 48.3%) and improved visual outcome (56.2% vs. 33.1%) in the endoscopic cohorts.…”

Section: Craniopharyngiomasmentioning

confidence: 99%

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

Cutler

Barkhoudarian

Griffiths³

et al. 2013

Innovative Neurosurgery

View full text Add to dashboard Cite

Given refinements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques and anatomical understanding, the endonasal endoscopic approach is now a well-accepted and widely utilized technique for removal of many if not most midline ventral skull base tumors. Pituitary adenomas and Rathke ' s cleft cysts (RCCs) constitute the majority of lesions removed via this route; however, craniopharyngiomas, clival chordomas, midline meningiomas and other benign and malignant skull base tumors are now increasingly removed by this approach. Herein we describe the evolution of the endonasal endoscopic technique, its current use for sellar and midline skull base tumors and potential for future innovation.

show abstract

“…The addition of the operative microscope and later the endoscope has expanded the application of submucosal dissection from the simple repair of nasal septal deflections to tumor resection, CSF fistula repair, and even aneurysm clipping. 1,3,9,10,13,[20][21][22] In general, the Freer is best used to perform dissection at the interface between a hard structure and soft tissue. In this manner, the Freer has been used to dissect the nail bed from the nail or to strip periosteum from bone.…”

mentioning

confidence: 99%

Dr. Otto “Tiger” Freer: inventor and innovator

Chittiboina

Connor

Nanda

2012

FOC

View full text Add to dashboard Cite

Every neurosurgeon develops his or her own standard approach to common intracranial pathologies in terms of the order in which different stages are performed and which instruments are used to perform individual tasks. The majority of the basic steps in performing a craniotomy are learned through repetition and practice during residency training. Significant amounts of energy are devoted to mastering technical skills and developing an operative rhythm. What often receives little attention is the historical origin of the instruments that make the work possible. The Freer elevator represents a particularly interesting example. To people unfamiliar with the accomplishments of turn-of-the-century laryngologist Otto “Tiger” Freer, it can be assumed that the name of the instrument in one's hand is simply named for what it can do, that is, to “free” the nasal mucosa from the bony and cartilaginous septum during the transsphenoidal approach. The technique this master surgeon spent his life and career perfecting is now repeated almost daily by skull base neurosurgeons approaching pathologies from the inferior frontal lobe to the foramen magnum. In reviewing his life and work, the authors of this paper discovered an interesting creative process that led to the design of the eponymous instrument. Additionally, they discovered important advances toward the development of the transnasal approach and in our understanding of the anterior skull base. They present a historical perspective on the life and accomplishments of Dr. Freer and the ubiquitous surgical instrument that he invented and popularized.

show abstract

Endoscopic Endonasal Compared with Microscopic Transsphenoidal and Open Transcranial Resection of Craniopharyngiomas

Cited by 230 publications

References 87 publications

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

Dr. Otto “Tiger” Freer: inventor and innovator

Contact Info

Product

Resources

About