TY - JOUR
T1 - Endoscopic and Microscopic Transsphenoidal Surgery of Craniopharyngiomas
T2 - A Systematic Review of Surgical Outcomes over Two Decades
AU - Cagnazzo, Federico
AU - Zoli, Matteo
AU - Mazzatenta, Diego
AU - Gompel, Jamie J.Van
N1 - Publisher Copyright:
© 2018 Georg Thieme Verlag KG Stuttgart.New York.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - 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.
AB - 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.
KW - craniopharyngioma
KW - endoscopic
KW - microsurgical resection
KW - transsphenoidal
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U2 - 10.1055/s-0037-1607195
DO - 10.1055/s-0037-1607195
M3 - Review article
C2 - 29195268
AN - SCOPUS:85036585920
SN - 2193-6315
VL - 79
SP - 247
EP - 256
JO - Journal of Neurological Surgery, Part A: Central European Neurosurgery
JF - Journal of Neurological Surgery, Part A: Central European Neurosurgery
IS - 3
ER -