Perioperative Complications in Endoscopic Endonasal versus Transcranial Resections of Adult Craniopharyngiomas

xlomafota13 shared this article with you from Inoreader Perioperative Complications in Endoscopic Endonasal versus Transcranial Resections of Adult Craniopharyngiomas Via leak of cerebrospinal fluid World Neurosurg. 2021 Jun 18:S1878-8750(21)00897-4. doi: 10.1016/j.wneu.2021.06.066. Online ahead of print. ABSTRACT INTRODUCTION: Adult craniopharyngiomas are low-grade tumors of the pituitary infundibulum that can be locally aggressive and frequently present with profound visual deficits and endocrinopathies. Surgical resection remains the preferred initial treatment for these lesions and recently endoscopic endonasal approaches (EEAs) have become increasingly utilized. However, minimal data exists comparing these techniques to traditional transcranial (TC) methods. The purpose of this study was to evaluate perioperative differences in EEA and TC approaches for adult craniopharyngiomas over the last several decades. METHODS: Craniopharyngioma surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. Complication rates, mortality rates, and annual treatment trends were stratified by procedure. Annual caseloa d was assessed with linear regression and multivariate logistic regression models were created to determine predictors of inpatient mortality and perioperative complications. RESULTS: From 1998-2014, a significant increase in EEAs for craniopharyngiomas (+4.36/year, r2=0.80, p<0.0001) was observed. In contrast, no increase in TC surgeries for these lesions was seen. In multivariate analysis, EEAs were more likely to experience postoperative cerebrospinal fluid leak (OR=2.61, p<0.0001). However, EEAs were protective against all other perioperative complications, including diabetes insipidus, panhypopituitarism, visual impairment, and even mortality (OR=0.41, p=0.0007). CONCLUSION: Over the last several decades, utilization of EEAs to resect adult craniopharyngiomas has increased. EEAs appear to be associated with lower rates of perioperative mortality and complications. However, long-term, prospective studies controlling for tumor size, location, and preo perative symptomatology are needed to determine when one approach should be utilized preferentially over the other. PMID:34153480 | DOI:10.1016/j.wneu.2021.06.066 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.