Surgical Management of Craniopharyngiomas in Children: Meta-analysis and Comparison of Transcranial and Transsphenoidal Approaches
Surgical Management of Craniopharyngiomas in Children: Meta-analysis and Comparison of Transcranial and Transsphenoidal Approaches
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DOI：
10.1227/neu.0b013e31821a872d
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发表时间：
2011-09-01
期刊：
影响因子：
4.8
通讯作者：
Wisoff, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Elliott, Robert E.;Jane, John A., Jr.;Wisoff, Jeffrey H.
背景：关于儿童颅咽管瘤的最佳治疗仍然存在争议。目的：我们对报道的一系列儿童颅咽管瘤经颅(TC)和经蝶窦(TS)手术进行荟萃分析，以确定TS和TC手术的结果之间的比较是否有效。方法：在线搜索英文文章，报道1990-2010年间发表的与儿童颅咽管瘤手术治疗相关的可量化结果数据。48项研究描述了2955名接受TC手术的患者，13项研究描述了373名接受TS手术的患者符合纳入标准。结果：在手术前，接受TC手术的患者视力损失较少，脑积水较多，颅内压升高，肿瘤较大，鞍上疾病较多。术后，TC组患者大部切除率较低，术后复发较多，神经系统发病率较高，尿崩症较多，改善较少，视力下降较大。在手术死亡率、肥胖/吞噬功能亢进或总存活率方面没有差异。结论：直接比较儿童颅咽管瘤TC和TS手术后的结果似乎是无效的。每种入路患者的基线差异产生了选择偏差，这可能解释了疾病控制率的提高和TS切除术的较低发病率。虽然TS入路越来越多地用于较小的肿瘤和主要位于鞍内的肿瘤，但更适合于TC手术的肿瘤包括有明显侧方伸展的大肿瘤、吞噬血管结构的肿瘤和有明显外围钙化的肿瘤。
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 whether 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: Before surgery, patients who had TC surgery had less visual loss, more frequent hydrocephalus and increased intracranial pressure, larger tumors, and more suprasellar disease. After 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 after 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. Although TS approaches are becoming increasingly used 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.