Pituitary

, Volume 17, Issue 4, pp 349–356

A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors

  • Christopher S. Graffeo
  • August R. Dietrich
  • Bartosz Grobelny
  • Meng Zhang
  • Judith D. Goldberg
  • John G. Golfinos
  • Richard Lebowitz
  • David Kleinberg
  • Dimitris G. Placantonakis
Article

DOI: 10.1007/s11102-013-0508-y

Cite this article as:
Graffeo, C.S., Dietrich, A.R., Grobelny, B. et al. Pituitary (2014) 17: 349. doi:10.1007/s11102-013-0508-y

Abstract

Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations.

Keywords

Endoscopic skull base surgery Literature review Tuberculum sellae meningioma Olfactory groove meningioma Craniopharyngioma Clival chordoma 

Abbreviations

TSM

Tuberculum sellae meningioma

OGM

Olfactory groove meningioma,

CRA

Craniopharyngioma

CHO

Clival chordoma

CSF

Cerebrospinal fluid

GTR

Gross total resection

DI

Diabetes insipidus

CNS

Central nervous system

Supplementary material

11102_2013_508_MOESM1_ESM.docx (393 kb)
Supplementary material 1 (DOCX 393 kb)

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Christopher S. Graffeo
    • 1
  • August R. Dietrich
    • 1
  • Bartosz Grobelny
    • 1
  • Meng Zhang
    • 2
  • Judith D. Goldberg
    • 2
  • John G. Golfinos
    • 1
  • Richard Lebowitz
    • 3
  • David Kleinberg
    • 4
  • Dimitris G. Placantonakis
    • 1
  1. 1.Department of NeurosurgeryNew York University School of MedicineNew YorkUSA
  2. 2.Department of Population Health and Environmental MedicineNew York University School of MedicineNew YorkUSA
  3. 3.Department of OtolaryngologyNew York University School of MedicineNew YorkUSA
  4. 4.Department of Medicine, Division of NeuroendocrinologyNew York University School of MedicineNew YorkUSA

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