title: Transfrontal and Transsphenoidal Approaches to Pediatric Craniopharyngioma: A National Perspective.
abstract: BACKGROUND
  This study compared transsphenoidal (TS) and transfrontal (TF) approaches to craniopharyngioma utilizing a national database.
  
  
  METHODS
  The Kids' Inpatient Database (2003, 2006, and 2009) was surveyed for patients with a diagnosis of craniopharyngioma who underwent a subset of surgical interventions to compare TS and TF surgery. Demographics, hospital variables, and complications/comorbidities were analyzed with multivariate regression.
  
  
  RESULTS
  314 admissions (TS = 104, TF = 210) were identified. The mean age was 14.8 (TS) versus 9.8 (TF) years (p < 0.001). The mean number of diagnoses was 4.6 (TS) versus 6.2 (TF) (p < 0.001). Diabetes insipidus was associated with 38% (TS) and 69% (TF). Cerebrospinal fluid (CSF) leak affected 19% TS and 4% TF resections. Other complications and comorbidities included postoperative stroke (2% TS vs. 5% TF), panhypopituitarism (5 vs. 8%), death (0 vs. 1%), cranial nerve deficits (1 vs. 6%), thrombotic events (7 vs. 17%), and seizures (0 vs. 12%). 98% of patients were discharged home after a mean 6-day length of stay (LOS) after TS, whereas 90% of TF patients had a LOS of 12 days. TS cases were more likely to be privately insured (68%) and from higher income brackets (61%) than TF ones (56 and 2%, respectively) (p < 0.05). In multivariate regression models adjusting for age, sex, race, number of diagnoses, surgical approach, hospital volume, and insurance type, the TS approach was associated with an increased incidence of CSF leak (OR 10, p < 0.001). More documented diagnoses (OR 16-60, p < 0.01) and TF approach (OR 2.6, p < 0.01) were associated with an increased incidence of other complications and comorbidities. Age younger than 10 (β-coefficient 2.3, p = 0.01), more diagnoses (β-coefficient 1.2, p < 0.001), and TF approach (β- coefficient 3.0, p < 0.01) were associated with increased LOS. A higher number of diagnoses were associated with nonhome discharge destinations (β-coefficient 1.29, p < 0.001).
  
  
  CONCLUSIONS
  TS surgery was associated with an increased incidence of CSF leak but shorter LOS; TF surgery was associated with an increased incidence of other complications. Patients undergoing TS surgery were more likely to have private insurance and a higher family income bracket.
authors.affiliation: Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, USA.
authors.forename: Yimo
authors.initials: Y
authors.lastname: Lin
authors.forename: Daniel
authors.initials: D
authors.lastname: Hansen
authors.forename: Christina M
authors.initials: CM
authors.lastname: Sayama
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Pan
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D002648:Child; D003397:Craniopharyngioma / Q000150:complications*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Craniopharyngioma, pediatric; Craniotomy; Transfrontal approach; Transsphenoidal approach