ABSTRACT
In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal-Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person's characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.
ABSTRACT
Los bioindicadores representan marcadores puntuales y selectos de stres para todos los niveles de la organizacion biologicas,permitiendo evaluar y predecir los efectos de las modificaciones ambientales antes que el daño sea irreversible.Los bioindicadores histologicos,inmunologicos,hematologicos,bioquimicos y moleculares se encuentran en los marcadores mas importantes.El trabajo analiza bioindicadores hematologicos e inmunologicos en dos especies de peces del lago San Roque.Las partes i y II de este articulo fueron publicados en los Nº 37 y 38 de dicha revista
Subject(s)
Argentina , Pollution of Lakes and Impoundments , Fishes , EutrophicationABSTRACT
Los bioindicadores representan marcadores puntuales y selectos de stres para todos los niveles de la organizacion biologicas,permitiendo evaluar y predecir los efectos de las modificaciones ambientales antes que el daño sea irreversible.Los bioindicadores histologicos,inmunologicos,hematologicos,bioquimicos y moleculares se encuentran en los marcadores mas importantes.El trabajo analiza bioindicadores hematologicos e inmunologicos en dos especies de peces del lago San Roque.Las partes i y II de este articulo fueron publicados en los Nº 37 y 38 de dicha revista
