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.
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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
References
Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT (2001) The history and evolution of transsphenoidal surgery. J Neurosurg 95(6):1083–1096. doi:10.3171/jns.2001.95.6.1083
Goudakos JK, Markou KD, Georgalas C (2011) Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clin Otolaryngol 36(3):212–220. doi:10.1111/j.1749-4486.2011.02331.x
Tabaee A, Anand VK, Barron Y, Hiltzik DH, Brown SM, Kacker A, Mazumdar M, Schwartz TH (2009) Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 111(3):545–554. doi:10.3171/2007.12.17635
Goel A, Muzumdar D, Desai KI (2002) Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51(6), 1358–1363; discussion 1363–1354
Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96(2):235–243. doi:10.3171/jns.2002.96.2.0235
Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(Suppl 5):v1–49. doi:10.1093/neuonc/nos218
Kane AJ, Sughrue ME, Rutkowski MJ, Shangari G, Fang S, McDermott MW, Berger MS, Parsa AT (2011) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 117(6):1272–1278. doi:10.1002/cncr.25591
Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89(4):547–551. doi:10.3171/jns.1998.89.4.0547
Bulow B, Attewell R, Hagmar L, Malmstrom P, Nordstrom CH, Erfurth EM (1998) Postoperative prognosis in craniopharyngioma with respect to cardiovascular mortality, survival, and tumor recurrence. J Clin Endocrinol Metab 83(11):3897–3904
McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control CCC 12(1):1–11
Gay E, Sekhar LN, Rubinstein E, Wright DC, Sen C, Janecka IP, Snyderman CH (1995) Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36(5), 887–896; discussion 896–887
Kitano M, Taneda M, Nakao Y (2007) Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. J Neurosurg 107(2):337–346. doi:10.3171/JNS-07/08/0337
Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3), 539–547; discussion 547–550
Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92(6):1028–1035. doi:10.3171/jns.2000.92.6.1028
Elliott RE, Jane JA Jr, Wisoff JH (2011) Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69(3), 630–643; discussion 643. doi:10.1227/NEU.0b013e31821a872d
Telera S, Carapella CM, Caroli F, Crispo F, Cristalli G, Raus L, Sperduti I, Pompili A (2012) Supraorbital keyhole approach for removal of midline anterior cranial fossa meningiomas: a series of 20 consecutive cases. Neurosurgical review 35(1), 67–83; discussion 83. doi:10.1007/s10143-011-0340-7
Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH (2010) Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 67(3 Suppl Operative), ons150–158; discussion ons158. doi:10.1227/01.NEU.0000383130.80179.41
Mascarenhas L, Moshel YA, Bayad F, Szentirmai O, Salek AA, Leng LZ, Hofstetter CP, Placantonakis DG, Tsiouris AJ, Anand VK, Schwartz TH (2013) The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions. Avoidance of CSF leak and lessons learned. World Neurosurg. doi:10.1016/j.wneu.2013.02.032
Acknowledgments
The authors would like to thank Dr. Chandra Sen at NYU School of Medicine, Department of Neurosurgery, for his critical reading of the manuscript. Meng Zhang, PhD, and Judith D. Goldberg, ScD, were supported by Grant UL1 TR000038 from the National Center for the Advancement of Translational Science (NCATS), National Institutes of Health.
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Graffeo, C.S., Dietrich, A.R., Grobelny, B. et al. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors. Pituitary 17, 349–356 (2014). https://doi.org/10.1007/s11102-013-0508-y
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DOI: https://doi.org/10.1007/s11102-013-0508-y