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

Federico Cagnazzo, Matteo Zoli, Diego Mazzatenta, Jamie Van Gompel

Research output: Contribution to journalArticle

3 Scopus citations


Objective Few studies have compared transsphenoidal endoscopic (TE) and transsphenoidal microscopic (TM) techniques for the treatment of craniopharyngiomas. Design We performed a systematic review of published series. The results were stratified in two time periods from 1995 to 2016. Results A total of 48 articles and 1,186 patients met the inclusion criteria. Overall, 60% of endoscopic cases were supradiaphragmatic, and 76% of microsurgical cases were infradiaphragmatic. Mean tumor size was 3 cm and 2.4 cm in the TE and TM series, respectively ( p = 0.008). Total resection rate was similar (66%) between TE and TM. Considering the surgical outcome for different tumor locations, total resection rate was slightly higher in the TE for supradiaphragmatic lesions (59% versus 42.5%; p = 0.26). Recurrence rate was higher in the endoscopic series (21.7% versus 12%). Mortality and the overall complication rates were similar ( p = 0.84). However, hydrocephalus (7.6%) and cognitive dysfunction (15.8%) were more common in TE, and meningitis (6%) and endocrinologic complications were more common in the TM series. In the past 6 years, the rate of cerebrospinal fluid leak in TE was significantly lower (13%) and was comparable between TE and TM. Conclusion 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.

Original languageEnglish (US)
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
StateAccepted/In press - Dec 1 2017



  • craniopharyngioma
  • endoscopic
  • microsurgical resection
  • transsphenoidal

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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