Outcomes after craniotomy for resection of craniopharyngiomas in adults: analysis of the National Surgical Quality Improvement Program (NSQIP)

Abstract

Purpose Craniopharyngiomas occur in suprasellar locations that pose challenges for surgical management. This study evaluates the incidence of complications following craniotomy for craniopharyngioma in adults and investigates risk factors for these complications. Methods Patients who underwent craniotomy for excision of craniopharyngioma were identified from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Incidence of 30-day postoperative complications was determined. Multivariable logistic regression identified demographic, comorbid and perioperative characteristics associated with any complication and major (Clavien IV) complications. Results There were 143 cases identified. Fifty-one (35.7%) had a complication, twenty (14.0%) experienced a major complication and there were four (2.8%) deaths. The most common complications were: unplanned readmission (13.3%), prolonged ventilation > 48 h (9.8%), and unplanned reoperation (9.3%). In multivariable analysis, variables significantly associated with any complication were: black race (OR 0.16; 95% CI 0.03-0.84; p = 0.03), hypertension (OR 5.04; 95% CI 1.79-14.17; p = 0.002) and longer duration of surgery (OR 1.27; 95% CI 1.01-1.58; p = 0.04). Hypertension (OR 9.33; 95% CI 1.61-54.21; p = 0.01) and longer duration of surgery (OR 1.51; 95% CI 1.05-2.17; p = 0.03) were also significant predictors for major complications. Conclusion One-third of patients undergoing craniotomy for craniopharyngioma resection experienced a postoperative complication. While high, this contrasts previously reported rates of two-thirds. Prolonged operative time and hypertension are positive predictors of major complications. This information can assist in counseling patients and decision-making for management. We note that other treatment approaches, such as endoscopic surgical techniques, radiosurgery and radiation therapy likely have different profiles and predictors of complications.

Clinical Outcomes of Transcranial and Endoscopic Endonasal Surgery for Craniopharyngiomas: A Single-Institution Experience

“…Typically, the surgical outcome is closely associated with the extent of resection (3,7,22). Reports showed that the extent of resection is an independent predictor of tumor recurrence (7,16,17,(23)(24)(25).…”

The Treatment Outcomes of Olfactory Neuroblastoma Patients With Frontal Lobe Invasion

“…Craniotomy was thought to be the optimal surgical modality for the treatment of ONB patients with intracranial involvement. However, craniotomy may lead to complications such as cerebrospinal fluid leak, meningitis, brain abscess, mental status changes, hematoma, and hemorrhage (9)(10)(11). While craniotomy can achieve adequate access to the invaded portion of the anterior skull base in advanced ONB, the transnasal approach should be used in selective patients on a case-by-case basis with a careful review of imaging and patient's anatomy (12).…”

Assessment of postoperative complications in craniopharyngioma patients: An approach based on the heterogeneous tumor-hypothalamus relationship

“…e middle column shows significant bivariate relationships between the pathological features displayed in the adjacent panels in the same row and the surgical outcome, in a cohort of 200 CP patients treated in the magnetic resonance imaging (MRI) era (P < 0.001). [5,7] (a) Brain specimen of a CP (t) without hypothalamic involvement. Note the tumor is expanding in the sellar and suprasellar compartments, below an intact third ventricle floor (3VF).…”

“…In this context, attention should be drawn here to a recent study by Rock et al, from the Department of Neurosurgery at Virginia Commonwealth University in Richmond, VA, USA, that analyzed the incidence of surgical complications in 143 CPs operated on in different centers in the United States. [7] is article focused on the set of information related to the occurrence of intra-and/or postoperative complications in CP surgery, a matter of special concern at a time when unsatisfactory surgical results are not generally the subject of open discussion. As an initial approach to this subject, Rock et al analyzed common unsatisfactory neurosurgical results, such as unexpectedly prolonged ventilation, reoperation, and/or readmission within the 1 st month following surgery.…”

“…As an initial approach to this subject, Rock et al analyzed common unsatisfactory neurosurgical results, such as unexpectedly prolonged ventilation, reoperation, and/or readmission within the 1 st month following surgery. [7] Nevertheless, and despite their commendable effort, this type of analysis provides little insight into the nature of surgical complications in CP patients, as the postoperative variables selected are insufficient to truly grasp the intricacies of these lesions. Contrary to other neurosurgical conditions, CPs are extremely heterogeneous regarding their topography, gross morphology, and, most importantly, their degree of hypothalamic involvement.…”