Endoscopic endonasal resection versus open surgery for pediatric craniopharyngioma: comparison of outcomes and complications

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Craniopharyngioma represents up to 10% of pediatric brain tumors. Although these lesions are benign, attempts at gross-total resection (GTR) can lead to serious complications. More conservative approaches have emerged but require adjuvant radiation. Endoscopic endonasal surgery (EES) aimed at GTR has the potential to result in fewer complications, but there has been limited comparison to open surgery. The authors performed a review of these two approaches within their institution to elucidate potential benefits and complication differences.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective review of pediatric patients undergoing resection of craniopharyngioma at their institution between 2001 and 2017. Volumetric analysis of tumor size and postoperative ischemic injury was performed. Charts were reviewed for a number of outcome measures.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 43 patients with an average age of 8.2 years were identified. Open surgery was the initial intervention in 15 and EES in 28. EES was performed in patients 3–17 years of age. EES has been the only approach used since 2011. In the entire cohort, GTR was more common in the EES group (85.7% vs 53.3%, p = 0.03). Recurrence rate (40% vs 14.2%, p = 0.13) and need for adjuvant radiation (20.0% vs 10.7%, p = 0.71) were higher in the open surgical group, although not statistically significant. Pseudoaneurysm development was only observed in the open surgical group. Volumetric imaging analysis showed a trend toward larger preoperative tumor volumes in the open surgical group, so a matched cohort analysis was performed with the largest tumors from the EES group. This revealed no difference in residual tumor volume (p = 0.28), but the volume of postoperative ischemia was still significantly larger in the open group (p = 0.004). Postoperative weight gain was more common in the open surgical group, a statistically significant finding in the complete patient group that trended toward significance in the matched cohort groups. Body mass index at follow-up correlated with volume of ischemic injury in regression analysis of the complete patient cohort (p = 0.05).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>EES was associated with similar, if not better, extent of resection and significantly less ischemic injury than open surgery. Pseudoaneurysms were only seen in the open surgical group. Weight gain was also less prevalent in the EES cohort and appears be correlated with extent of ischemic injury at time of surgery.</jats:p></jats:sec>

Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta‐analysis

“…A total of 25 studies met inclusion criteria for qualitative and quantitative analysis. 1,7,11,21-42 See Figure 1 for a summary of search results. A funnel plot indicating less likelihood of publication bias across studies is presented in Figure 2 .…”

Endoscopic endonasal surgery outcomes for pediatric craniopharyngioma: a systematic review

“…In a retrospective review, Madsen et al 13 explored the outcomes and complications of an EES (n = 28) versus open surgery (n = 15) for craniopharyngiomas in pediatric patients with a mean age of 8.2 years. A matched cohort analysis was performed to compare the 11 patients with the largest tumors in the endoscopic group to 11 patients in the open surgery group.…”

“…When EES is utilized as the first-line treatment for pediatric craniopharyngiomas, patients experience better outcomes and reduced recurrence rates overall compared to those for whom EES is a secondary procedure, 9,19 although this is confounded by the fact that lesions requiring staged treatment or reoperation are inherently more likely to present with increased rates of complications and recurrence. Compared to microsurgery, EES was identified to be superior by Madsen et al 13 after controlling for tumor size. It should be noted that directly comparing transcranial approaches to EES is complicated by inherent selection bias such that EES is typically reserved for smaller sellar lesions, as purely suprasellar craniopharyngiomas are believed to be better treated with microsurgery.…”

The expanded endonasal approach in pediatric skull base surgery: A review

“…The treatment choice should be tailored individually given the high survival rate and potential lifetime complications related to injury to the optic apparatus or hypothalamus . Madsen et al demonstrated that GTR is possible in 85.7% of endonasal cases vs 53.3% in open approaches and the recurrence rate (40% vs 14.2%) and need for adjuvant therapy (20.0% vs 10.7%) are higher in open approaches . This trend toward improved resection and decreased recurrence with judicious application of endonasal approaches to pediatric craniopharyngioma are seen in multiple additional series .…”