Document Detail


Surgical Management of Craniopharyngiomas in Children: Meta-analysis and Comparison of Transcranial and Transsphenoidal Approaches.
MedLine Citation:
PMID:  21499159     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Controversy persists regarding the optimal treatment of pediatric craniopharyngiomas. OBJECTIVE:: We performed a meta-analysis of reported series of transcranial (TC) and transsphenoidal (TS) surgery for pediatric craniopharyngiomas to determine if comparisons between the outcomes in TS and TC approaches are valid. METHODS:: Online databases were searched for English-language articles reporting quantifiable outcome data published between 1990 and 2010 pertaining to the surgical treatment of pediatric craniopharyngiomas. Forty-eight studies describing 2955 patients having TC surgery and 13 studies describing 373 patients having TS surgery met inclusion criteria. RESULTS:: Prior to surgery, patients who had TC surgery had less visual loss, more frequent hydrocephalus and elevated intracranial pressure (ICP), larger tumors and more suprasellar disease. Following surgery, patients in the TC group had lower rates of gross-total-resection (GTR), more frequent recurrence after GTR, higher neurological morbidity, more frequent diabetes insipidus, less improvement and greater deterioration in vision. There was no difference in operative mortality, obesity/hyperphagia or overall survival percentages. CONCLUSION:: Directly comparing outcomes following TC and TS surgery for pediatric craniopharyngiomas does not appear to be valid. Baseline differences in patients who underwent each approach create selection bias that may explain the improved rates of disease control and lower morbidity of TS resection. While TS approaches are becoming increasingly utilized for smaller tumors and those primarily intrasellar, tumors more amenable to TC surgery include large tumors with significant lateral extension, those that engulf vascular structures and those with significant peripheral calcification.
Authors:
Robert E Elliott; John A Jane; Jeffrey H Wisoff
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, New York University School of Medicine, New York, NY; Department of Neurosurgery and Pediatrics, University of Virginia, Charlottesville, VA; Department of Neurosurgery and Pediatrics, New York University School of Medicine, New York, NY.
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