Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
Ricardo J. Komotar, Robert M. Starke, Daniel M.S. Raper, Vijay K. Anand, Theodore H. Schwartz
ObjectiveCraniopharyngiomas have traditionally represented a challenge for open transcranial or transsphenoidal microscopic neurosurgery, due to their anatomical location and proximity to vital neurovascular structures. The extended endoscopic endonasal transsphenoidal approach has been more recently developed as a potentially surgically aggressive, yet minimal access, alternative. In order to gain a more comprehensive assessment of the benefits and limitations of the various approaches to resection of craniopharyngiomas, we have performed a systematic review of the available published reports following endoscope-assisted endonasal approaches and compared their results with transsphenoidal purely microscope-based or transcranial microscope-based techniques.MethodsWe performed a MEDLINE search of the modern literature (1995-2010) to identify open and endoscopic surgical series for pediatric and adult craniopharyngiomas. Comparisons were made for patient and tumor characteristics as well as extent of resection, morbidity, and visual outcome. Statistical analyses of categorical variables were undertaken using Chi-square and Fisher's exact tests with post-hoc Bonferroni analysis to compare endoscopic, microsurgical transsphenoidal and transcranial approaches.ResultsEighty eight studies, involving 3470 patients, were included. The endoscopic cohort had a significantly higher rate of gross total resection (66.9% vs. 48.3%; p<0.003) and improved visual outcome (56.2% vs. 33.1%; p<0.003) compared with the open cohort. The transsphenoidal cohort had similar outcomes to the endoscopic group. The rate of CSF leak was higher in the endoscopic (18.4%) and transsphenoidal (9.0%) than in the transcranial group (2.6%) (p<0.003), but the transcranial group had a higher rate of seizure (8.5%), which did not occur in the endonasal or transsphenoidal groups (p<0.003).ConclusionThe endoscopic endonasal approach is a safe and effective alternative for the treatment of certain craniopharyngiomas. Larger lesions with more lateral extension may be more suitable for an open approach, and further follow-up is needed to assess the long-term efficacy of this minimal access approach.
Source: World Neurosurgery, Available online 1 November 2011
Ricardo J. Komotar, Robert M. Starke, Daniel M.S. Raper, Vijay K. Anand, Theodore H. Schwartz
ObjectiveCraniopharyngiomas have traditionally represented a challenge for open transcranial or transsphenoidal microscopic neurosurgery, due to their anatomical location and proximity to vital neurovascular structures. The extended endoscopic endonasal transsphenoidal approach has been more recently developed as a potentially surgically aggressive, yet minimal access, alternative. In order to gain a more comprehensive assessment of the benefits and limitations of the various approaches to resection of craniopharyngiomas, we have performed a systematic review of the available published reports following endoscope-assisted endonasal approaches and compared their results with transsphenoidal purely microscope-based or transcranial microscope-based techniques.MethodsWe performed a MEDLINE search of the modern literature (1995-2010) to identify open and endoscopic surgical series for pediatric and adult craniopharyngiomas. Comparisons were made for patient and tumor characteristics as well as extent of resection, morbidity, and visual outcome. Statistical analyses of categorical variables were undertaken using Chi-square and Fisher's exact tests with post-hoc Bonferroni analysis to compare endoscopic, microsurgical transsphenoidal and transcranial approaches.ResultsEighty eight studies, involving 3470 patients, were included. The endoscopic cohort had a significantly higher rate of gross total resection (66.9% vs. 48.3%; p<0.003) and improved visual outcome (56.2% vs. 33.1%; p<0.003) compared with the open cohort. The transsphenoidal cohort had similar outcomes to the endoscopic group. The rate of CSF leak was higher in the endoscopic (18.4%) and transsphenoidal (9.0%) than in the transcranial group (2.6%) (p<0.003), but the transcranial group had a higher rate of seizure (8.5%), which did not occur in the endonasal or transsphenoidal groups (p<0.003).ConclusionThe endoscopic endonasal approach is a safe and effective alternative for the treatment of certain craniopharyngiomas. Larger lesions with more lateral extension may be more suitable for an open approach, and further follow-up is needed to assess the long-term efficacy of this minimal access approach.
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