Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma: Systematic Review and Meta-Analysis

World Neurosurg. 2019 Jul:127:e656-e668. doi: 10.1016/j.wneu.2019.03.239. Epub 2019 Apr 1.


Objective: The optimal surgical strategy for management of adult patients with craniopharyngioma remains controversial. To analyze the functional outcomes ofadult patients with gross total resection (GTR) and subtotal resection (STR) of craniopharyngioma.

Methods: MEDLINE, EMBASE, Scopus, and Cochrane databases were searched from inception to July 19, 2018, for articles comparing postoperative endocrine function, vision, complications, and recurrence rates for adult patients with GTR and STR of craniopharyngioma. The articles were analyzed by meta-analysis of proportions using a random-effects model to calculate summary odds ratios (ORs).

Results: The initial search resulted in 2468 studies and 540 studies selected for full text review. Seventeen studies were included in the final analyses with 748 patients in the GTR cohort and 559 patients in the STR cohort. GTR resulted in a significantly lower likelihood of recurrence when compared with STR (OR, 0.106; 95% confidence interval [CI], 0.067-0.168; P < 0.001), but a significantly greater likelihood of panhypopituitarism (OR, 2.063; 95% CI, 1.058-4.024; P = 0.034) and permanent diabetes insipidus (OR, 2.776; 95% CI, 1.321-5.832; P = 0.007). There was no significant difference between the groups for postoperative worsened vision (P = 0.868), improved vision (P = 0.876), pathologic weight gain (P = 0.724), cerebrospinal fluid leak (P = 0.788), complications (P = 0.656), or death (P = 0.261).

Conclusions: This is the first systematic review of functional outcomes of adult patients with craniopharyngioma. GTR results in decreased likelihood of recurrence, but increased likelihood of postoperative panhypopituitarsm and permanent diabetes insipidus. Surgeons should be aware of these associations when determining the optimal operative strategy for adult patients with craniopharyngioma.

Keywords: Craniopharyngioma; Gross total resection; Panhypopituitarism; Subtotal resection.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Craniopharyngioma / diagnosis
  • Craniopharyngioma / surgery*
  • Endocrine System Diseases / diagnosis
  • Endocrine System Diseases / etiology*
  • Female
  • Humans
  • Male
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Treatment Outcome
  • Vision Disorders / diagnosis
  • Vision Disorders / etiology*