2025 Poster Presentations
P330: UNDERSTANDING SURGEON DECISION-MAKING BETWEEN ENDOSCOPIC ENDONASAL AND OPEN TRANSCRANIAL APPROACHES FOR CRANIOPHARYNGIOMA: A SYSTEMATIC REVIEW OF IMAGING AND TUMOR CHARACTERISTICS
Geena Jung; Joshua Cohen; David Oriko; Anne Lally; Emery Buckner-Wolfson; Margaret Keymakh; Hailey Reisert; Timothy Kim; Ryan Fatemi; Andres Pasuizaca; Seyed Ahmad Naseri Alavi; Genesis Liriano; Andrew Kobets; Albert Einstein College of Medicine/Montefiore Medical Center
Background: Craniopharyngiomas are rare tumors that typically arise in the suprasellar region of the brain. Left untreated, they have the potential to cause debilitating complications including vision loss and cognitive decline. Craniopharyngiomas can be resected through either an endoscopic endonasal (EEA) or open, transcranial approach, but the indications for each have not been clearly defined. Here, we seek to review the literature and compare the tumor and clinical characteristics of lesions resected by the EEA versus open approach.
Methodology: A comprehensive database search was performed on PubMed, Google Scholar, and Embase using key terms. Studies were included if the institution utilized both EEA and open approaches for surgical resection of craniopharyngiomas. Systematic reviews, meta-analyses, case reports, and articles not written in English were excluded.
Results: A total of 16 studies met inclusion criteria and were deemed suitable for data extraction. Most studies did not report a difference in demographic characteristics of patients undergoing EEA vs an open approach for craniopharyngioma resection. No studies reported a significant difference in tumor location, consistency, pathologic type, or presence of calcification. Only one study reported an increased preoperative tumor volume with the open approach. In 3 out of 16 studies, gross total resection (GTR) was found to be significantly more common in the endoscopic group. The open approach was found to be significantly associated with a longer follow-up period (4/16) and hospital length of stay (2/16), and a greater rate of recurrence (2/16) and mortality (1/16). New onset diabetes insipidus (3/16) and vision deterioration (3/16) following surgery was significantly more common following an open approach.
Conclusions: Inherent in the surgical decision-making regarding approach are the anatomical considerations of the tumor. Interestingly, we found that tumor characteristics through the literature search were not substantially different for the different approaches, even though this is consistent with our clinical experience. This may be related to the development and refinement of endonasal techniques which allow larger, suprasellar tumors to be amenable to GTR more than in the past. We found that EEA shows advantages in achieving higher rates of GTR and reducing hospital length of stay, while the open, transcranial approach is associated with more postoperative complications and a greater rate of recurrence. Considerations of these factors are critical when determining the surgical management of patients with craniopharyngiomas.