• Jonathan C Pang, Dean D Chung, Jenny Wang, Arash Abiri, Brian V Lien, Alexander S Himstead, Andrew Ovakimyan, Michael G Kim, HsuFrank P KFPKDepartment of Neurological Surgery, University of California, Irvine, Orange, CA, USA., and Edward C Kuan.
• Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
• Neurosurgery. 2023 Jun 1; 92 (6): 111211291112-1129.

BackgroundCraniopharyngiomas 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.ObjectiveTo compare treatments and outcomes between adult and pediatric craniopharyngiomas.MethodsThis 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.ResultsThe 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.ConclusionAdult 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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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