Endonasal endoscopic resection of suprasellar craniopharyngioma: A retrospective single-center case series

Risk Factors for Intracranial Infection in Surgical Patients with Suprasellar Craniopharyngiomas by an Expanded Endoscopic Endonasal Approach: A Single-Center Initial Experience

OBJECTIVE

To explore the risk factors for intracranial infection in surgical patients with suprasellar craniopharyngiomas by an expanded endoscopic endonasal approach (EEEA) in a single center.

METHODS

Forty-one patients with suprasellar craniopharyngiomaswere retrospectively recruited. EEEA was applied in all patients. All patients were evaluated for the occurrence of intracranial infection after surgery, and the risk factors of infection were further analyzed. The databases of PubMed and Web of Science were systematically reviewed to identify the rate of meningitis with suprasellar craniopharyngiomas treated with extended endoscopic endonasal transsphenoidal surgery (EETS).

RESULTS

Intracranial infection occurred in 21.95% of patients. Patients who were diagnosed as recurrent tumor presented with significant higher incidence of infection than that in the patients with first surgery (55.56% vs. 18.75%; P < 0.05). The rate of the third ventricle exposure was 88.89% in 9 infected patients, which was significantly higher than 40.63% in uninfected patients (P < 0.05). The risk factor for postsurgery infection was the exposure of third ventricle during surgery (P = 0.043; odds ratio = 10.374). The incidence of EETS meningitis varies from 0% to 30%, and the rate of cerebrospinal fluid leak varies from 0% to 58% in previous studies. Twenty three patients received gentamicin physiological saline irrigation in our study, and only 2 presented intracranial infection after surgery.

CONCLUSIONS

The rate of EETS meningitis varies from 0% to 30% according to previous studies. Opening of the third ventricle during surgery was an independent risk factor for intracranial infection in surgical patients with suprasellar craniopharyngiomas by EEEA. Gentamicin physiological saline irrigation during surgery might prevent postsurgical infection.

Effects and mechanisms of nutritional interventions on extradigestive complications in obese patients

BACKGROUND

Obesity is associated with an increased risk of multiple extradigestive complications. Thus, understanding the global epidemiology of obesity and its relationship with extradigestive complications, such as cardiovascular disease, type 2 diabetes mellitus, and non-alcoholic fatty liver disease is important. However, nutritional intervention can positively manage issues associated with obesity. Hence, the identification of the current high prevalence of extradigestive complications among patients with obesity and the potential role of nutritional interventions is also essential.

AIM

To determine the relationship between obesity and extradigestive complications and emphasize the importance of nutritional interventions in the management of patients with obesity.

METHODS

Overall, 110 patients with obesity admitted to our hospital from February 2020 to November 2022 and 100 healthy individuals were included in the present study. Information of the study population, including demographic characteristics, such as age, sex, body mass index, indicators of extradigestive complications, dietary intake, and biomarkers was collected. The study design, participant selection, interventions, and development of the nutritional intervention program were described. The collected data were analyzed to assess the effect of nutritional interventions on extradigestive complications.

RESULTS

As a part of nutritional intervention, the dietary structure was modified to decrease the saturated fatty acid and cholesterol intake and increase the dietary fiber and polyunsaturated fatty acid intake to improve the blood lipid levels and cardiovascular health. Mechanistic studies showed that these nutritional interventions positively affected mechanisms that regulate lipid metabolism, improved inflammatory markers in the blood, and improved vascular functions.

CONCLUSION

The study discusses the consistency of the present results with previous findings to assess the clinical significance of the present findings. The study provides direction for future research on improving nutritional intervention strategies.

Comparing Surgical Approaches for Craniopharyngioma Resection Among Adults and Children: A Meta-analysis and Systematic Review

BACKGROUND

Craniopharyngioma treatment often necessitates surgical resection. Conventional approaches, such as transcranial and transsphenoidal approaches, are predominantly used. However, a recently adopted supraorbital approach may be more efficacious. Thus, this meta-analysis and systematic review aimed to compare the efficacy of the transcranial, transsphenoidal, and supraorbital approaches for resection and treatment of craniopharyngiomas.

METHODS

This study was performed following PRISMA guidelines. Analyses were performed according to study design: (1) analyses for studies comparing several surgical approaches; and (2) analyses of all included studies. Random effects meta-analysis models were used to pool odds ratios among studies comparing several approaches. Similarly, categorical meta-regression models were used to examine the effect of surgical approach as a covariate of outcome data for all studies. Statistics were performed using Comprehensive Meta-Analysis software (CMA 3.3, Biostat, Englewood, NJ) (significance set at P < 0.05).

RESULTS

Patients were well-matched for age, sex, and preoperative comorbidities between groups stratified by surgical approach. Analyses including 22 studies that compared several approaches demonstrated that the transsphenoidal group had a greater occurrence of postoperative visual improvement (P < 0.0001), lesser occurrence of visual deterioration (P < 0.0001), and lower tumor recurrence rate (P = 0.015) compared with the transcranial group. Only 2 studies compared the supraorbital approach to another approach, limiting analyses. Analyses including all studies demonstrated that the supraorbital group did not differ to either the transcranial or transsphenoidal group for any examined variables.

CONCLUSIONS

The present study suggests that the transsphenoidal approach is associated with improved clinical outcomes for craniopharyngioma resection. There are limited data regarding the supraorbital approach, warranting future investigation.

Current Advances in the Management of Adult Craniopharyngiomas

Craniopharyngiomas (CPs) are slow growing, histologically benign intracranial tumors located in the sellar–suprasellar region. Although known to have low mortality, their location and relationship to the adjacent neural structures results in patients having significant neurologic, endocrine, and visual comorbidities. The invasive nature of this tumor makes complete resection a challenge and contributes to its recurrence. Additionally, these tumors are bimodally distributed, being treated with surgery, and are followed by other adjuncts, such as focused radiation therapy, e.g., Gamma knife. Advances in surgical techniques, imaging tools, and instrumentations have resulted in the evolution of surgery using endoscopic techniques, with residual components being treated by radiotherapy to target the residual tumor. Advances in molecular biology have elucidated the main pathways involved in tumor development and recurrence, but presently, no other treatments are offered to patients, besides surgery, radiation, and endocrine management, as the disease and tumor evolve. We review the contemporary management of these tumors, from the evolution of surgical treatments, utilizing standard open microscopic approaches to the more recent endoscopic surgery, and discuss the current recommendations for care of these patients. We discuss the developments in radiation therapy, such as radiosurgery, being used as treatment strategies for craniopharyngioma, highlighting their beneficial effects on tumor resections while decreasing the rates of adverse outcomes. We also outline the recent chemotherapy modalities, which help control tumor growth, and the immune landscape on craniopharyngiomas that allow the development of novel immunotherapies.