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Published on: January 17, 2018
Transfrontal and Transsphenoidal Approaches to Pediatric Craniopharyngioma: A National Perspective
Yimo Lin1, Daniel Hansen, Christina M Sayama
1Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, USA.
Insights
Transsphenoidal (TS) surgery for craniopharyngioma resulted in more cerebrospinal fluid (CSF) leaks but shorter hospital stays. Transfrontal (TF) surgery was linked to more complications, with TS patients having better insurance and income.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Health Services Research
Background:
- Craniopharyngioma treatment involves surgical approaches like transsphenoidal (TS) and transfrontal (TF).
- Comparing the outcomes and patient characteristics of these surgical methods is crucial for optimizing care.
Purpose of the Study:
- To compare the safety and effectiveness of transsphenoidal (TS) versus transfrontal (TF) surgical approaches for craniopharyngioma.
- To analyze patient demographics, hospital variables, and complication rates associated with each surgical approach.
Main Methods:
- Utilized the Kids' Inpatient Database (2003, 2006, 2009) to identify patients with craniopharyngioma.
- Analyzed data on demographics, hospital variables, complications, and comorbidities using multivariate regression for TS and TF surgery comparison.
Main Results:
- Transsphenoidal (TS) surgery was associated with a higher incidence of cerebrospinal fluid (CSF) leak (19% vs. 4%) but a shorter length of stay (6 days vs. 12 days).
- Transfrontal (TF) surgery had a higher rate of other complications (e.g., cranial nerve deficits, seizures) and was associated with longer hospital stays, particularly in younger patients.
- Patients undergoing TS surgery were more likely to have private insurance and higher family income compared to those undergoing TF surgery.
Conclusions:
- The transsphenoidal (TS) approach for craniopharyngioma is linked to an increased risk of CSF leak but a shorter hospital length of stay.
- The transfrontal (TF) approach is associated with a higher incidence of other complications and longer hospitalizations.
- Socioeconomic factors, including insurance status and income, differ between patients undergoing TS and TF surgery.
Introduction:
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).
Conclusion:
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.
