Abstract
Objective Few studies have compared transsphenoidal endoscopic (TE) and transsphenoidal microscopic
(TM) techniques for the treatment of craniopharyngiomas.
Design We performed a systematic review of published series. The results were stratified
in two time periods from 1995 to 2016.
Results A total of 48 articles and 1,186 patients met the inclusion criteria. Overall, 60%
of endoscopic cases were supradiaphragmatic, and 76% of microsurgical cases were infradiaphragmatic.
Mean tumor size was 3 cm and 2.4 cm in the TE and TM series, respectively (p = 0.008). Total resection rate was similar (66%) between TE and TM. Considering the
surgical outcome for different tumor locations, total resection rate was slightly
higher in the TE for supradiaphragmatic lesions (59% versus 42.5%; p = 0.26). Recurrence rate was higher in the endoscopic series (21.7% versus 12%).
Mortality and the overall complication rates were similar (p = 0.84). However, hydrocephalus (7.6%) and cognitive dysfunction (15.8%) were more
common in TE, and meningitis (6%) and endocrinologic complications were more common
in the TM series. In the past 6 years, the rate of cerebrospinal fluid leak in TE
was significantly lower (13%) and was comparable between TE and TM.
Conclusion Both techniques appear comparable for infradiaphragmatic lesions; however, TE seems
to yield better results for supradiaphragmatic tumors. In conclusion, more complex
lesions with difficult locations can be effectively treated with endoscopic surgery.
Keywords
craniopharyngioma - endoscopic - microsurgical resection - transsphenoidal
