Endoscopic endonasal versus open approach for craniopharyngioma treatment: a systematic review of clinical characteristics.

Background: Craniopharyngiomas are rare tumors found in the suprasellar region of the brain. Untreated, they have the potential to cause debilitating complications, including vision loss and cognitive decline. Craniopharyngiomas can be resected through several surgical options including endoscopic endonasal (EEA) and open, transcranial approaches, cystic drainage, and ventricular neuroendoscopic approaches. Here, we seek to review the literature and compare characteristics of lesions resected by the EEA versus open approach.

Methods: A comprehensive database search was performed on PubMed, Google Scholar, and Embase using key terms. Included studies utilized both EEA and open approaches for craniopharyngioma resection.

Results: No studies reported a significant difference in tumor location, consistency, pathology, or presence of calcification. One study reported an increased preoperative tumor volume with the open approach. The open approach was significantly associated with a longer follow-up period (4/16) and hospital length of stay (2/16), as well as a greater rate of recurrence (2/16) and mortality (1/16). New-onset diabetes insipidus (3/16) and vision deterioration (3/16) following surgery were significantly more common following an open approach.

Conclusion: Inherent in the surgical decision-making regarding approach are the anatomical considerations of the tumor. Through our literature search, we found tumors were not substantially different for the different approaches, consistent with our clinical experience. This may be related to the refinement of endonasal techniques, allowing larger, suprasellar tumors to be amenable to GTR more than in the past.