Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma: Systematic Review and Meta-Analysis

Oluwaseun O. Akinduro, Alessandro Izzo, Victor M. Lu, Luca Ricciardi, Daniel Trifiletti, Jennifer L. Peterson, Victor Bernet, Angela Donaldson, Eric Eggenberger, Osarenoma Olomu, Ronald Reimer, Robert Wharen, Alfredo Quinones-Hinojosa, Kaisorn L. Chaichana

Research output: Contribution to journalArticle

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Abstract

Objective: The optimal surgical strategy for management of adult patients with craniopharyngioma remains controversial. To analyze the functional outcomes ofadult patients with gross total resection (GTR) and subtotal resection (STR) of craniopharyngioma. Methods: MEDLINE, EMBASE, Scopus, and Cochrane databases were searched from inception to July 19, 2018, for articles comparing postoperative endocrine function, vision, complications, and recurrence rates for adult patients with GTR and STR of craniopharyngioma. The articles were analyzed by meta-analysis of proportions using a random-effects model to calculate summary odds ratios (ORs). Results: The initial search resulted in 2468 studies and 540 studies selected for full text review. Seventeen studies were included in the final analyses with 748 patients in the GTR cohort and 559 patients in the STR cohort. GTR resulted in a significantly lower likelihood of recurrence when compared with STR (OR, 0.106; 95% confidence interval [CI], 0.067–0.168; P < 0.001), but a significantly greater likelihood of panhypopituitarism (OR, 2.063; 95% CI, 1.058–4.024; P = 0.034) and permanent diabetes insipidus (OR, 2.776; 95% CI, 1.321–5.832; P = 0.007). There was no significant difference between the groups for postoperative worsened vision (P = 0.868), improved vision (P = 0.876), pathologic weight gain (P = 0.724), cerebrospinal fluid leak (P = 0.788), complications (P = 0.656), or death (P = 0.261). Conclusions: This is the first systematic review of functional outcomes of adult patients with craniopharyngioma. GTR results in decreased likelihood of recurrence, but increased likelihood of postoperative panhypopituitarsm and permanent diabetes insipidus. Surgeons should be aware of these associations when determining the optimal operative strategy for adult patients with craniopharyngioma.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Craniopharyngioma
Meta-Analysis
Odds Ratio
Diabetes Insipidus
Confidence Intervals
Recurrence
MEDLINE
Weight Gain
Databases

Keywords

  • Craniopharyngioma
  • Gross total resection
  • Panhypopituitarism
  • Subtotal resection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma : Systematic Review and Meta-Analysis. / Akinduro, Oluwaseun O.; Izzo, Alessandro; Lu, Victor M.; Ricciardi, Luca; Trifiletti, Daniel; Peterson, Jennifer L.; Bernet, Victor; Donaldson, Angela; Eggenberger, Eric; Olomu, Osarenoma; Reimer, Ronald; Wharen, Robert; Quinones-Hinojosa, Alfredo; Chaichana, Kaisorn L.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Akinduro, Oluwaseun O. ; Izzo, Alessandro ; Lu, Victor M. ; Ricciardi, Luca ; Trifiletti, Daniel ; Peterson, Jennifer L. ; Bernet, Victor ; Donaldson, Angela ; Eggenberger, Eric ; Olomu, Osarenoma ; Reimer, Ronald ; Wharen, Robert ; Quinones-Hinojosa, Alfredo ; Chaichana, Kaisorn L. / Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma : Systematic Review and Meta-Analysis. In: World neurosurgery. 2019.
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abstract = "Objective: The optimal surgical strategy for management of adult patients with craniopharyngioma remains controversial. To analyze the functional outcomes ofadult patients with gross total resection (GTR) and subtotal resection (STR) of craniopharyngioma. Methods: MEDLINE, EMBASE, Scopus, and Cochrane databases were searched from inception to July 19, 2018, for articles comparing postoperative endocrine function, vision, complications, and recurrence rates for adult patients with GTR and STR of craniopharyngioma. The articles were analyzed by meta-analysis of proportions using a random-effects model to calculate summary odds ratios (ORs). Results: The initial search resulted in 2468 studies and 540 studies selected for full text review. Seventeen studies were included in the final analyses with 748 patients in the GTR cohort and 559 patients in the STR cohort. GTR resulted in a significantly lower likelihood of recurrence when compared with STR (OR, 0.106; 95{\%} confidence interval [CI], 0.067–0.168; P < 0.001), but a significantly greater likelihood of panhypopituitarism (OR, 2.063; 95{\%} CI, 1.058–4.024; P = 0.034) and permanent diabetes insipidus (OR, 2.776; 95{\%} CI, 1.321–5.832; P = 0.007). There was no significant difference between the groups for postoperative worsened vision (P = 0.868), improved vision (P = 0.876), pathologic weight gain (P = 0.724), cerebrospinal fluid leak (P = 0.788), complications (P = 0.656), or death (P = 0.261). Conclusions: This is the first systematic review of functional outcomes of adult patients with craniopharyngioma. GTR results in decreased likelihood of recurrence, but increased likelihood of postoperative panhypopituitarsm and permanent diabetes insipidus. Surgeons should be aware of these associations when determining the optimal operative strategy for adult patients with craniopharyngioma.",
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T2 - Systematic Review and Meta-Analysis

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AU - Izzo, Alessandro

AU - Lu, Victor M.

AU - Ricciardi, Luca

AU - Trifiletti, Daniel

AU - Peterson, Jennifer L.

AU - Bernet, Victor

AU - Donaldson, Angela

AU - Eggenberger, Eric

AU - Olomu, Osarenoma

AU - Reimer, Ronald

AU - Wharen, Robert

AU - Quinones-Hinojosa, Alfredo

AU - Chaichana, Kaisorn L.

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N2 - Objective: The optimal surgical strategy for management of adult patients with craniopharyngioma remains controversial. To analyze the functional outcomes ofadult patients with gross total resection (GTR) and subtotal resection (STR) of craniopharyngioma. Methods: MEDLINE, EMBASE, Scopus, and Cochrane databases were searched from inception to July 19, 2018, for articles comparing postoperative endocrine function, vision, complications, and recurrence rates for adult patients with GTR and STR of craniopharyngioma. The articles were analyzed by meta-analysis of proportions using a random-effects model to calculate summary odds ratios (ORs). Results: The initial search resulted in 2468 studies and 540 studies selected for full text review. Seventeen studies were included in the final analyses with 748 patients in the GTR cohort and 559 patients in the STR cohort. GTR resulted in a significantly lower likelihood of recurrence when compared with STR (OR, 0.106; 95% confidence interval [CI], 0.067–0.168; P < 0.001), but a significantly greater likelihood of panhypopituitarism (OR, 2.063; 95% CI, 1.058–4.024; P = 0.034) and permanent diabetes insipidus (OR, 2.776; 95% CI, 1.321–5.832; P = 0.007). There was no significant difference between the groups for postoperative worsened vision (P = 0.868), improved vision (P = 0.876), pathologic weight gain (P = 0.724), cerebrospinal fluid leak (P = 0.788), complications (P = 0.656), or death (P = 0.261). Conclusions: This is the first systematic review of functional outcomes of adult patients with craniopharyngioma. GTR results in decreased likelihood of recurrence, but increased likelihood of postoperative panhypopituitarsm and permanent diabetes insipidus. Surgeons should be aware of these associations when determining the optimal operative strategy for adult patients with craniopharyngioma.

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