• Ernest J Bobeff, Bartosz M Szmyd, Ming Shen, Dariusz J Jaskólski, and Theodore H Schwartz.
• Department of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; Department of Neurosurgery, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland; Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland.
• World Neurosurg. 2025 Feb 11: 123769123769.

BacgroundCraniopharyngioma is a benign, locally invasive tumor of the sellar-suprasellar region. Surgery can be curative but may require sacrifice of the pituitary stalk, which often leads to hypopituitarism. The risk/benefit of this maneuver is not well understood.MethodsWe performed a systematic English literature search on craniopharyngioma surgery with data on stalk preservation. We used meta-analysis for odds ratio in R software. We have also used available raw data for recurrence risk using the Kaplan-Meier curve.ResultsSignificantly lower recurrence risk was noted in patients in whom the stalk was sacrificed (11% vs. 23%, p=0.003). This held true in patients after endoscopic endonasal approach (EEA) regardless of the extent of resection (p=0.001), and in patients with GTR after EEA (p=0.032). Survival analysis confirmed lower recurrence risk in adults with GTR after EEA and stalk sacrifice (p=0.007, log-rank test). In patients with stalk sacrifice, the risk of panhypopituitarism was more than doubled (85% vs. 40%; p<0.001), as was the risk of somatotrope insufficiency (89% vs. 32%; p<0.001). Additionally, there was an approximate 30% increase in the risk of hypocortisolemia (94% vs. 62%; p<0.001), hypothyroidism (96% vs. 59%; p<0.001), gonadotrope insufficiency (92% vs. 59%; p<0.001), and diabetes insipidus (80% vs. 55%; p<0.001). The risk of weight gain was also significantly increased (30% vs. 16%; p=0.025).ConclusionsOur review indicates that stalk sacrifice is often required to achieve a durable cure in patients with craniopharyngiomas. While stalk sacrifice increases the risk of post-operative endocrinopathy, even if the stalk is preserved many patients will still become hypopituitary.Copyright © 2025. Published by Elsevier Inc.

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