Endoscopic Endonasal Approach versus Transcranial Approach for Surgical Treatment OF Craniopharyngioma

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Introduction: Craniopharyngiomas are rare, benign tumors originating from the craniopharyngeal duct, commonly occurring in the sellar/parasellar area. These tumors, often feature cystic and calcified components (WHO Grade I). There are two types: adamantinomatous (ACP), deriving from Rathke’s pouch remnants, and papillary (PCP), arising from metaplastic adenohypophyseal cells. Their incidence peaks in children aged 5–14 and adults 50–7. Traditionally removed via the transcranial approach (TCA), the extended endoscopic endonasal approach (EEA) became more frequent in the past decades, although its efficacy compared with TCA remains debatable. Objective: The aim of our study was to examine the benefits and limitations of these two approaches more comprehensively based on comparative studies. Methods: We conducted a literature review registered in PROSPERO in accordance with the PRISMA guidelines for systematic reviews using PubMed, Google Scholar, and MEDLINE. A total of 208 articles were analyzed and 5 studies satisfied our inclusion criteria: English Language, randomized controlled trials, extend of resection, visual outcomes, and postoperative complications. Results: Five studies were screened, including 82 patients. EEA had greater rate of gross total resection (GTR) ([OR], 2.15; 95% [CI]; p = 0.025) with an incidence of 63.2% versus 51.3%. TCA had significantly lower risk of CSF leakage (OR, 0.30; p = 0.012) compared with EEA. Additionally, TCA showed higher likelihood of visual deterioration (OR, 3.75; p = 0.001), associated with, but not significantly, to diabetes insipidus (OR, 1.118; p = 0.490) and panhypopituitarism (OR, 1.33; p = 0.210). Conclusion: When both approaches can completely resect the tumor, EEA outperforms TCA in terms of GTR rate with lower probability of visual deterioration, as well as favorable results in terms of complications, except CSF leakage and lateral extension of the tumor. Although recent guidelines and investigations promote EEA as the golden standard surgical treatment method, further analysis is required. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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