Tag: Preservation

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Effect of pituitary stalk preservation during craniopharyngioma removal on pituitary function, extent of resection, and recurrence: systematic review and meta-analysis

J Neurosurg 142:741–755, 2025

The meta-analysis evaluates the impact of pituitary stalk preservation during craniopharyngioma surgery on pituitary function, resection extent, and recurrence. Preservation reduces diabetes insipidus risk but may increase incomplete resection risk in pediatric patients. Results are cautious due to small study sizes and reporting biases.

• Pituitary stalk preservation reduces risk of postoperative diabetes insipidus (DI) and anterior pituitary dysfunction.

• Preservation shows no significant impact on tumor recurrence or extent of resection.

• Pediatric patients face higher risk of incomplete resection with stalk preservation.

• Meta-analysis included 33 studies with 2366 patients.

• Significant heterogeneity observed in DI and recurrence risk across studies.

• Stalk preservation benefits posterior pituitary function long-term, not anterior.

• High risk of bias in individual studies; findings should be interpreted cautiously.

• Subgroup analysis highlights higher recurrence risk in pediatric stalk preservation.

• Egger’s test indicates publication bias in DI analysis.

• Previous meta-analysis by Li et al. lacked age stratification and EEA cases.

• Authors recommend careful consideration of stalk preservation in pediatric cases.

• Lack of age-stratified data limits analysis and may increase bias.

• Study methods followed PRISMA guidelines, with data extracted from eligible studies

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Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery

Acta Neurochirurgica (2021) 163:2219–2224

Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.

Methods The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.

Results Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.

Conclusion Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.

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