Association of pituitary stalk management with endocrine outcomes and recurrence in microsurgery of craniopharyngiomas: A meta-analysis

• Preservation of pituitary stalk reduced the occurrence rate of diabetes insipidus.
• Preservation of pituitary stalk reduced impairment of endocrine function.
• Preservation of pituitary stalk enhance the CP recurrence rate.

ObjectiveA craniopharyngioma (CP) is a benign tumor commonly considered to originate from the pituitary stalk. However, it is still controversial as to whether the pituitary stalk should be maintained after microsurgery to resect the tumor despite its own physiological function of the pituitary stalk. In this study, meta-analysis was conducted to evaluate the influence of the pituitary stalk resection on endocrine function and tumor recurrence rate.MethodsThe relevant publications were identified by searching databases including Pubmed, Embase, Medline, and Web of Science. The extracted data were used as the basis for the meta-analysis by the RevMan 5.2 software program.ResultsSeven articles were selected, including 420 clinical cases. The meta-analysis showed that retaining the pituitary stalk might reduce the occurrence rate of diabetes insipidus (OR = 0.21, 95%CI = 0.10, 0.46, P = 0.0001) and the risk of potential impairment of anterior pituitary function (OR = 0.04, 95%CI = 0.01, 0.13, P < 0.0001). However, there was no significant relationship between craniopharyngioma recurrence and pituitary stalk treatment (i.e., preservation or resection) (OR = 1.40, 95%CI = 0.59, 3.34, P = 0.45).ConclusionThe maintenance of the pituitary stalk may reduce the alterations in endocrine function and the occurrence of diabetes insipidus. However, it is not likely to enhance the recurrence rate of craniopharyngiomas.