Craniopharyngioma resection by endoscopic endonasal approach versus transcranial approach: A systematic review and meta-analysis of comparative studies

Min Kyun Na; Bohyoung Jang; Kyu-Sun Choi; Tae Ho Lim; Wonhee Kim; Youngsuk Cho; Hyun-Goo Shin; Chiwon Ahn; Jae Guk Kim; Juncheol Lee; Sae Min Kwon; Heekyung Lee

doi:10.3389/fonc.2022.1058329

Craniopharyngioma resection by endoscopic endonasal approach versus transcranial approach: A systematic review and meta-analysis of comparative studies

Front Oncol. 2022 Nov 30:12:1058329. doi: 10.3389/fonc.2022.1058329. eCollection 2022.

Authors

Min Kyun Na¹, Bohyoung Jang², Kyu-Sun Choi¹, Tae Ho Lim³, Wonhee Kim⁴, Youngsuk Cho⁴, Hyun-Goo Shin³, Chiwon Ahn⁵, Jae Guk Kim⁴, Juncheol Lee³, Sae Min Kwon⁶, Heekyung Lee³

Affiliations

¹ Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, South Korea.
² Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
³ Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
⁴ Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon, South Korea.
⁵ Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
⁶ Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.

Abstract

Introduction: The transcranial approach (TCA) has historically been used to remove craniopharyngiomas. Although the extended endoscopic endonasal approach (EEA) to these tumors has been more commonly accepted in the recent two decades, there is debate over whether this approach leads to better outcomes. The goal of this systematic review and meta-analysis was to more comprehensively understand the benefits and limitations of these two approaches in craniopharyngioma resection based on comparative studies.

Methods: We conducted a systematic literature search in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations using MEDLINE, EMBASE, and the Cochrane Library. A total of 448 articles were screened. Data were extracted and analyzed using proportional meta-analysis. Eight comparative studies satisfied the inclusion criteria. The extent of resection, visual outcomes, and postoperative complications such as endocrine dysfunction and cerebrospinal fluid (CSF) leakage were compared.

Results and discussion: Eight studies, involving 376 patients, were included. Resection by EEA led to a greater rate of gross total resection (GTR) (odds ratio [OR], 2.42; p = 0.02; seven studies) with an incidence of 61.3% vs. 50.5% and a higher likelihood of visual improvement (OR, 3.22; p < 0.0001; six studies). However, TCA resulted in a higher likelihood of visual deterioration (OR, 3.68; p = 0.002; seven studies), and was related, though not significantly, to panhypopituitarism (OR, 1.39; p = 0.34; eight studies) and diabetes insipidus (OR, 1.14; p = 0.58; seven studies). Although TCA showed significantly lower likelihoods of CSF leakage (OR, 0.26; 95% confidence interval [CI], 0.10-0.71; p = 0.008; eight studies) compared to EEA, there was no significant difference in meningitis (OR, 0.92; 95% CI, 0.20-4.25; p = 0.91; six studies) between the two approaches. When both approaches can completely resect the tumor, EEA outperforms TCA in terms of GTR rate and visual outcomes, with favorable results in complications other than CSF leakage, such as panhypopituitarism and diabetes insipidus. Although knowledge of and competence in traditional microsurgery and endoscopic surgery are essential in surgical decision-making for craniopharyngioma treatment, when both approaches are feasible, EEA is associated with favorable surgical outcomes.

Systematic review registration: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021234801.

Keywords: craniopharyngioma; endoscopic endonasal approach; metaanalysis; systematic review; transcranial approach.

Publication types

Systematic Review