Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas

Allergy & Rhinology

Review

Marc Otten¹  Jeffrey Bruce¹  Maeher R. Grewal²  Jonathan B. Overdevest²  Chetan Safi²  Daniel B. Spielman²  David A. Gudis³ 

[1] Department of Neurologic Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York;Department of Otolaryngology – Head and Neck Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York;Department of Otolaryngology – Head and Neck Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York;Department of Neurologic Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York;

关键词: craniopharyngioma;    endoscopic skull base surgery;    gross total resection;    skull base tumor;    subtotal resection;   

DOI  :  10.1177/2152656720964158

来源: Sage Journals

【 摘 要 】

Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient’s individual tumor characteristics, risk, symptoms, and therapeutic goals.

【 授权许可】

CC BY-NC   
© The Author(s) 2020

【 图 表 】

Figure 6.