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Characteristics and Outcomes in Pediatric Versus Adult Craniopharyngiomas: A Systematic Review and Meta-Analysis
Jonathan C Pang1, Dean D Chung1, Jenny Wang1
1Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
Insights
Pediatric craniopharyngiomas present differently and lead to worse outcomes than adult tumors. Both groups require individualized, multidisciplinary care for optimal management of these rare brain tumors.
Area of Science:
- Neuro-oncology
- Pediatric neurosurgery
- Endocrinology
Background:
- Craniopharyngiomas are rare intracranial tumors with bimodal age distribution.
- Differences in presentation, treatment, and outcomes between pediatric and adult craniopharyngiomas are not well-characterized.
Approach:
- Systematic review and meta-analysis of studies reporting on craniopharyngioma surgery.
- Searched Web of Science, MEDLINE, and Scopus databases.
- Synthesized data from 106 studies (4,202 patients) and performed meta-analysis on 23 studies (735 patients).
Key Points:
- Pediatric craniopharyngiomas are associated with larger tumor size and more frequent headaches.
- Children experience higher rates of visual defects, cognitive impairment, diabetes insipidus, obesity, and neurological deficits post-surgery.
- No significant differences observed in recurrence, survival rates, or cerebrospinal fluid leak between age groups.
Conclusions:
- Significant differences exist in clinical presentation and functional outcomes between adult and pediatric craniopharyngiomas.
- Multimodality treatment and a multidisciplinary, individualized approach are crucial for managing these tumors.
- Further research is needed to optimize treatment strategies for distinct pediatric and adult populations.
Background:
Craniopharyngiomas account for 1.2% to 4.6% of all intracranial tumors. Although age at presentation is distributed bimodally, with a pediatric peak occurring between 5 and 15 years and an adult peak between 50 and 70 years, presentation, treatment, and outcome differences between these two craniopharyngioma populations have not been thoroughly characterized.
Objective:
To compare treatments and outcomes between adult and pediatric craniopharyngiomas.
Methods:
This is a systematic review and meta-analysis. Web of Science, MEDLINE, and Scopus databases were searched for primary studies reporting postoperative complications, functional outcomes, recurrence, and overall survival in patients with craniopharyngioma undergoing surgery.
Results:
The search yielded 1,202 unique articles, of which 106 (n=4,202 patients) met criteria for qualitative synthesis and 23 (n=735 patients) met criteria for meta-analysis. Compared with adult, pediatric craniopharyngiomas were less likely to present with visual defects (odds ratio [OR] 0.54, 95% CI 0.36-0.80) or cognitive impairment (OR 0.29, 95% CI 0.12-0.71) and more likely with headaches (OR 2.08, 95% CI 1.16-3.73). Children presented with significantly larger tumors compared with adults (standardized mean difference 0.68, 95% CI 0.38-0.97). Comparing functional outcomes, pediatric patients sustained higher rates of permanent diabetes insipidus (OR 1.70, 95% CI 1.13-2.56), obesity (OR 3.15, 95% CI 1.19-8.31), and cranial nerve and/or neurological defects (OR 4.87, 95% CI 1.78-13.31) than adults. No significant differences were found in rates of postoperative cerebrospinal fluid leak, overall or progression-free survival, or recurrence.
Conclusion:
Adult and pediatric craniopharyngiomas seem to have fundamental differences in clinical presentation and functional outcomes. These patients frequently require multimodality treatment and are best managed with a multidisciplinary team and an individualized approach.
