title: Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches.
abstract: BACKGROUND
  Controversy persists regarding the optimal treatment of pediatric craniopharyngiomas.
  
  
  OBJECTIVE
  We performed a meta-analysis of reported series of transcranial (TC) and transsphenoidal (TS) surgery for pediatric craniopharyngiomas to determine whether comparisons between the outcomes in TS and TC approaches are valid.
  
  
  METHODS
  Online databases were searched for English-language articles reporting quantifiable outcome data published between 1990 and 2010 pertaining to the surgical treatment of pediatric craniopharyngiomas. Forty-eight studies describing 2955 patients having TC surgery and 13 studies describing 373 patients having TS surgery met inclusion criteria.
  
  
  RESULTS
  Before surgery, patients who had TC surgery had less visual loss, more frequent hydrocephalus and increased intracranial pressure, larger tumors, and more suprasellar disease. After surgery, patients in the TC group had lower rates of gross total resection (GTR), more frequent recurrence after GTR, higher neurological morbidity, more frequent diabetes insipidus, less improvement, and greater deterioration in vision. There was no difference in operative mortality, obesity/hyperphagia, or overall survival percentages.
  
  
  CONCLUSIONS
  Directly comparing outcomes after TC and TS surgery for pediatric craniopharyngiomas does not appear to be valid. Baseline differences in patients who underwent each approach create selection bias that may explain the improved rates of disease control and lower morbidity of TS resection. Although TS approaches are becoming increasingly used for smaller tumors and those primarily intrasellar, tumors more amenable to TC surgery include large tumors with significant lateral extension, those that engulf vascular structures, and those with significant peripheral calcification.
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Elliott
authors.forename: John A
authors.initials: JA
authors.lastname: Jane
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Wisoff
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy; D003627:Data Interpretation, Statistical; D004724:Endoscopy; D005260:Female; D006801:Humans; D007027:Hypothalamic Diseases / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007427:Intracranial Pressure; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D059035:Perioperative Period / Q000401:mortality; D010900:Pituitary Diseases / Q000453:epidemiology / Q000209:etiology; D010911:Pituitary Neoplasms / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012886:Skull / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014785:Vision, Ocular; D055815:Young Adult