Abstract
BACKGROUND: Craniopharyngiomas pose a significant clinical challenge due to their complex anatomical location and potential for neurological sequelae. Surgical management options include transcranial and endoscopic approaches, each with its advantages and limitations. This systematic review and meta-analysis aims to comprehensively compare the outcomes of transcranial and endoscopic surgery for craniopharyngioma, integrating the latest evidence from ten pertinent journal articles. METHODS: A systematic search of electronic databases, including Google Scholar, PubMed, MEDLINE, and Embase, was conducted to identify relevant studies published between 2010 and 2022. A total of eight articles comparing outcomes of transcranial and endoscopic surgery for craniopharyngioma were included in the study. Data extraction and quality assessment were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The transcranial approach was less effective in achieving gross total resection (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32-0.70) compared to the endoscopic approach, with low heterogeneity (I(2) = 41%). However, both approaches had similar odds for near-total resection, subtotal resection, and partial resection. The transcranial approach was associated with lower odds of total neurological complications (OR = 0.6, 95% CI = 0.4-0.9), higher odds of tumor recurrence (OR = 1.86, 95% CI = 1.12-3.09), and lower odds of visual improvement (OR = 0.43, 95% CI = 0.32-0.58) compared to the endoscopic approach. There was no significant difference in mortality rate between the two approaches. CONCLUSION: Our meta-analysis comparing the efficacy of transcranial and endoscopic surgery for craniopharyngioma reveals that the endoscopic approach is preferred for managing specific conditions due to its higher likelihood of achieving complete resection and potentially better postsurgery outcomes, minimizing neurological complications.