TY - JOUR
T1 - Current Role of Endoscopic Endonasal Approach for Craniopharyngiomas
T2 - A 10-Year Systematic Review and Meta-Analysis Comparison with the Open Transcranial Approach
AU - Figueredo, Luisa F.
AU - Martínez, Andrea L.
AU - Suarez-Meade, Paola
AU - Marenco-Hillembrand, Lina
AU - Salazar, Andrés Felipe
AU - Pabon, Daniela
AU - Guzmán, Juan
AU - Murguiondo-Perez, Renata
AU - Hallak, Hana
AU - Godo, Alex
AU - Sandoval-Garcia, Carolina
AU - Ordoñez-Rubiano, Edgar G.
AU - Donaldson, Angela
AU - Chaichana, Kaisorn L.
AU - Peris-Celda, María
AU - Bendok, Bernard R.
AU - Samson, Susan L.
AU - Quinones-Hinojosa, Alfredo
AU - Almeida, Joao Paulo
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/6
Y1 - 2023/6
N2 - In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal–Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person’s characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.
AB - In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal–Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person’s characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.
KW - craniopharyngioma
KW - endoscopic endonasal
KW - meta-analysis
KW - microscopic transsphenoidal
KW - systematic review
KW - transcranial
UR - http://www.scopus.com/inward/record.url?scp=85163719626&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85163719626&partnerID=8YFLogxK
U2 - 10.3390/brainsci13060842
DO - 10.3390/brainsci13060842
M3 - Review article
AN - SCOPUS:85163719626
SN - 2076-3425
VL - 13
JO - Brain Sciences
JF - Brain Sciences
IS - 6
M1 - 842
ER -