Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

Background: The optimal therapeutic approach for adult craniopharyngioma remains controversial. Some advocate for gross total resection (GTR), while others support subtotal resection followed by adjuvant radiotherapy (STR + XRT). Methods: MEDLINE (1946 to July 1st 2016) and EMBASE (1980 to June 30th 2016) were systematically reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. At our institution, from 1975 to 2013, 33 patients were treated with initial surgical resection for adult onset craniopharyngioma. 22 patients were included in the present case series. Results: Eligible studies (n=21) were identified from the literature in addition to a case series of our institutional experience. Three groups were available for analysis: GTR, STR + XRT, and STR. The rates of recurrence were 17 %, 27 % and 45%, respectively. This differs from childhood population. The difference in risk of recurrence after GTR vs. STR + XRT did not reach significance (OR: 0.63, 95% confidence interval: 0.33-1.24, P=0.18). This maybe because of low pooled sample size (n=99) who underwent STR+XRT. Conclusions: This is the first and largest meta-analysis examining rate of recurrence in adult craniopharyngioma. Thus, when safe and feasible, a goal of gross total resection should be favored. Each patient should be considered on a case-by-case basis.

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SURG-16. SUPRATOTAL VERSUS GROSS TOTAL RESECTION OF GLIOBLASTOMA: A SYSTEMATIC REVIEW

Neuro-Oncology ◽

10.1093/neuonc/noz175.1017 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi243-vi243

Author(s):

Christina Jackson ◽

John Choi ◽

Carrie Price ◽

Chetan Bettegowda ◽

Michael Lim ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Gross Total Resection ◽

Cochrane Library ◽

Study Quality ◽

Total Resection ◽

Significant Difference ◽

Definition Of ◽

Supratotal Resection ◽

The Cochrane Library

Abstract INTRODUCTION Due to the infiltrative nature of glioblastoma(GBM) outside of the contrast enhancing region in the peritumoral zone, there is increasing movement to perform supratotal resections (SpTR) by extending the edge of resection beyond the contrast enhancing portion of the tumor. However, there is currently no consensus on the potential survival benefit of SpTR in GBM as compared to gross total resection (GTR). METHODS Therefore, we performed a systematic review using PRISMA guidelines and performed a comprehensive literature search on Pubmed, EMBASE, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov, from inception to August 16, 2018, to identify articles comparing overall survival (OS) after SpTR versus GTR. Furthermore, we assessed study quality using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS We identified 8902 unique citations, of which 11 articles and 2 abstracts met study inclusion criteria. 925 patients underwent SpTR out of a total of 2137 patients. 9 of the 13 studies demonstrated improved survival with SpTR compared to GTR (median improvement in OS of 10.5 months), with no significant difference in post-operative complication rate. Conversely, one abstract found worsened outcomes with SpTR compared to GTR (median decrease in OS of 4 months). However, overall study quality was poor, with 12 of the 13 studies of level IV evidence and one study of level IIIb evidence. We were unable to perform a meta-analysis due to significant clinical and methodological heterogeneity amongst the studies (e.g. differences in adjuvant therapy and lack of standardization of definition of supratotal resection). CONCLUSIONS Our systematic review indicates that SpTR may be associated with improved OS compared to GTR for GBM. However, this is limited by poor study quality and significant clinical and methodological heterogeneity amongst the studies. There is need for prospective clinical trials to further establish standardized guidelines for SpTR in GBM.

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Factors affecting outcome following treatment of patients with cavernous sinus meningiomas

Journal of Neurosurgery ◽

10.3171/2010.3.jns091807 ◽

2010 ◽

Vol 113 (5) ◽

pp. 1087-1092 ◽

Cited By ~ 43

Author(s):

Michael E. Sughrue ◽

Martin J. Rutkowski ◽

Derick Aranda ◽

Igor J. Barani ◽

Michael W. McDermott ◽

...

Keyword(s):

Cavernous Sinus ◽

Postoperative Radiotherapy ◽

Meta Analysis ◽

Survival Rates ◽

Extent Of Resection ◽

Gross Total Resection ◽

Cranial Neuropathy ◽

Tumor Control ◽

Subtotal Resection ◽

Total Resection

Object Although there is a considerable volume of literature available on the treatment of patients with cavernous sinus meningiomas (CSMs), most of the data regarding tumor control and survival come from case studies or single-institution series. The authors performed a meta-analysis of reported tumor control and survival rates of patients described in the published literature, with an emphasis on specific prognostic factors. Methods The authors systematically analyzed the published literature and found more than 3000 patients treated for CSMs. Separate meta-analyses were performed to calculate pooled rates of recurrence and cranial neuropathy after 1) gross-total resection, 2) subtotal resection without adjuvant postoperative radiotherapy or radiosurgery, and 3) stereotactic radiosurgery (SRS) alone. Results were expressed as pooled proportions, and random-effects models were used to incorporate any heterogeneity present to generate a pooled proportion. Individual studies were weighted using the inverse variance method, and 95% CIs for each group were calculated from the pooled proportions. Results A total of 2065 nonduplicated patients treated for CSM met inclusion criteria for the analysis. Comparisons of the 95% CIs for recurrence of these 3 cohorts revealed that SRS-treated patients experienced improved rates of recurrence (3.2% [95% CI 1.9–4.5%]) compared with either gross-total resection (11.8% [95% CI 7.4–16.1%]) or subtotal resection alone (11.1% [95% CI 6.6–15.7%]) (p < 0.01). The authors found that the pooled mixed-effects rate of cranial neuropathy was markedly higher in patients undergoing resection (59.6% [95% CI 50.3–67.5%]) than for those undergoing SRS alone (25.7% [95% CI 11.5–38.9%]) (p < 0.05). Conclusions Radiosurgery provided improved rates of tumor control compared with surgery alone, regardless of the subjective extent of resection.

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P.124 Meta-analysis comparing predictors of good postoperative seizure control in children with dysembryoplastic neuroepithelial tumors and gangliogliomas

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.223 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S48-S49

Author(s):

A Ranger ◽

D Diosy

Keyword(s):

Meta Analysis ◽

Gross Total Resection ◽

Seizure Freedom ◽

Tumor Type ◽

Total Resection ◽

Neuroepithelial Tumors ◽

Dysembryoplastic Neuroepithelial Tumors ◽

Not Otherwise Specified ◽

Age At Surgery ◽

Postoperative Seizure

Background: Dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas are the most common cause of tumor-related seizures in children and adolescents. Little is known about predictors of surgical success, in terms of seizure freedom. All relevant papers since 1995 were identified. Methods: Over 4000 abstracts were screened on MedLine to identify data comparing tumor type (DNET vs. ganglioglioma) and predictors of post-operative seizure freedom. Results: Seventeen papers were identified encompassing 97 DNET and 95 ganglioglioma patients. Fifteen patients were found with other neuroglial tumors (NGT) or NGT not-otherwise-specified. DNET patients were found to have less frequent seizures, more likely to have second lobe involvement, and to achieve gross total resection. Seizure freedom was achieved in roughly 80% of patients, with no distinction by tumor type, with no surgery-related or peri-operative deaths. For DNETs, seizure freedom was associated with shorter seizure duration, simple lesionectomy, gross total resection, and shorter duration of follow-up. In ganglioglioma patients, seizure freedom was associated with younger age at surgery, secondary generalization (unexpectedly), absence of dysplasia, and gross total resection. Gross total resection was the strongest predictor. Conclusions: Epilepsy surgery for DNET and ganglioglioma had similar outcomes with gross total resection being the strongest predictor.

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Comparing survival outcomes of gross total resection and subtotal resection with radiotherapy for craniopharyngioma: a meta-analysis

Journal of Surgical Research ◽

10.1016/j.jss.2018.01.029 ◽

2018 ◽

Vol 226 ◽

pp. 131-139 ◽

Cited By ~ 9

Author(s):

Guoqing Wang ◽

Xiaoyang Zhang ◽

Mengzhao Feng ◽

Fuyou Guo

Keyword(s):

Meta Analysis ◽

Gross Total Resection ◽

Survival Outcomes ◽

Subtotal Resection ◽

Total Resection

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A systematic review and meta-analysis of supratotal versus gross total resection for glioblastoma

Journal of Neuro-Oncology ◽

10.1007/s11060-020-03556-y ◽

2020 ◽

Vol 148 (3) ◽

pp. 419-431 ◽

Cited By ~ 5

Author(s):

Christina Jackson ◽

John Choi ◽

Adham M. Khalafallah ◽

Carrie Price ◽

Chetan Bettegowda ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Gross Total Resection ◽

Total Resection

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Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis

Radiation Oncology ◽

10.1186/s13014-021-01759-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Se-Woong Chun ◽

Kyung Min Kim ◽

Min-Sung Kim ◽

Ho Kang ◽

Yun-Sik Dho ◽

...

Keyword(s):

Local Recurrence ◽

Recurrence Rate ◽

Adjuvant Radiotherapy ◽

Local Recurrence Rate ◽

Meta Analysis ◽

Atypical Meningioma ◽

Gross Total Resection ◽

Survival Outcomes ◽

Total Resection ◽

The Impact

Abstract Background The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR. Methods PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel–Haenszel method and the inverse variance-weighted method, appropriately. Results Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36–0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity. Conclusions For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.

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Combined Frontotemporal Transbasal Approach for the Resection of a Giant Rathke's Cleft Cyst: Operative Video and Technical Nuances

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625947 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S276-S277

Author(s):

James Liu

Keyword(s):

Rathke’S Cleft Cyst ◽

Lateral Extension ◽

Rathke's Cleft Cyst ◽

Total Resection ◽

Anterior Clinoid Process ◽

Skull Base Approach ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft ◽

Neurologically Intact ◽

Neurovascular Structures

AbstractWe present a case of a giant Rathke's cleft cyst with significant superior extension into the third and right lateral ventricles and lateral extension into the left Sylvian fissure and over the anterior clinoid process. An extended modification of the frontotemporal approach was performed using a combined frontotemporal transbasal approach. This allowed wide exposure to both transsylvian and subfrontal corridors to the retrochiasmatic space. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, microdissection of the tumor, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient was neurologically intact with improved visual acuity. In summary, the combined frontotemporal transbasal approach is an important strategy in the armamentarium for the surgical management of giant Rathke's cleft cysts.The link to the video can be found at: https://youtu.be/UjhnUZVi03I.

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