Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA.
Neurosurgery. 2011 Sep;69(3):630-43; discussion 643. doi: 10.1227/NEU.0b013e31821a872d.
Controversy persists regarding the optimal treatment of pediatric craniopharyngiomas.
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.
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.
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.
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.
关于儿童颅咽管瘤的最佳治疗方法仍存在争议。
我们对经颅（TC）和经蝶（TS）手术治疗儿童颅咽管瘤的报道系列进行了荟萃分析，以确定 TS 和 TC 方法之间的结果比较是否有效。
在线数据库检索了 1990 年至 2010 年间发表的关于儿童颅咽管瘤手术治疗的可量化结果数据的英文文章。符合纳入标准的 48 项研究描述了 2955 例接受 TC 手术的患者，13 项研究描述了 373 例接受 TS 手术的患者。
在手术前，接受 TC 手术的患者视力丧失较少，脑积水和颅内压增高更为频繁，肿瘤较大，鞍上疾病更多。手术后，TC 组患者的大体全切除（GTR）率较低，GTR 后复发更为频繁，神经功能障碍发生率较高，尿崩症发生率较高，视力改善程度较低，恶化程度较高。手术死亡率、肥胖/贪食症或总生存率百分比无差异。
直接比较儿童颅咽管瘤 TC 和 TS 手术后的结果似乎是无效的。接受每种方法治疗的患者之间的基线差异造成了选择偏差，这可能解释了 TS 切除的疾病控制率提高和发病率降低的原因。虽然 TS 方法越来越多地用于较小的肿瘤和主要位于鞍内的肿瘤，但更适合 TC 手术的肿瘤包括具有显著侧向延伸的大肿瘤、包裹血管结构的肿瘤以及具有显著周围钙化的肿瘤。
