儿童颅咽管瘤 (CP) 的最佳手术方法仍然存在争议，选择偏差通常妨碍对经颅入路 (TCA) 和内镜鼻内入路 (EEA) 之间的结果进行公平比较。本系统综述的目的是分析 EEA 目前在儿科 CP 治疗中的作用，并确定在扩大其适应症后与 TCA 的比较是否有效。对 2010 年 2 月期间发表的英文文章的系统综述2022 年 6 月的研究是为了确定 MEDLINE (PubMed) 和 Embase 数据库中报告儿科 CP 切除的研究。其中包括报告通过 TCA 或 EEA 去除儿科 CP 的文章。病例报告、评论文章以及同一中心早期或不太全面的系列文章被排除在外。分析了基线特征和结果。评估了预测区间 (PI)、异质性（Q、I2 和 τ2 统计数据）和发表偏倚（漏斗图分析）。共有 835 名患者接受了 TCA（18 篇文章），403 名患者接受了 EEA（19 篇文章）。术前，患者平均年龄 (p = 0.055，PI = 5.05-15.11)、视力障碍 (p = 0.08，PI = 19.1-90.5，I2 = 80%) 和下丘脑综合征 (p = 0.17，PI = 6.5-52.2) ，I2 = 62%）在 EEA 组和 TCA 组之间没有显着差异。内分泌缺陷（垂体前叶缺陷 [p < 0.001，PI = 16.5-92.9，I2 = 81%] 和尿崩症 [p < 0.001，PI = 6.3-60.6，I2 = 43%]）在 EEA 组中更为常见。 TCA 组的脑积水和颅内压升高的体征/症状显着较高（分别为 p < 0.001，PI = 5.2-73.3，I2 = 70% vs p < 0.001，PI = 4.6-73，I2 = 62%）。复发病变（p = 0.52，PI = 2.7-87.3，I2 = 13%），肿瘤大小（p = 0.25，PI = 22.1-56.8），第三脑室受累（p = 0.053，PI = 10.9-81.3，I2 = 69） %）和下丘脑受累（p = 0.06，PI = 8.5-83.6，I2 = 79%）在两种方法之间没有显着差异。对于鞍上 CP，首选 EEA（p = 0.006，PI = 26.8-70.8，I2 = 40%），而对于纯鞍上 CP，首选 TCA（p = 0.007，PI = 13.5-81.1，I2 = 61%）。对于纯粹鞍内病变，两种方法之间没有差异（p = 0.94，PI = 0-62.7，I2 = 26%）。 PI、I2 值的广度和发表偏倚分析显示，汇总数据之间存在很大差异，阻碍了结果荟萃分析的可能性。随着扩展方法的采用，EEA 的使用变得适合更广泛的儿科 CP ，并取得了良好的成果。尽管由于患者群体和肿瘤亚型的差异，EEA 和 TCA 组的结果之间的公平比较受到阻碍，但鉴于 EEA 的多功能性增加和其使用专业知识的提高，外科医生现在可以根据独特的情况选择最佳的手术方法。每种儿科 CP 的优点和缺点。

The optimal surgical approach for pediatric craniopharyngiomas (CPs) remains a matter of debate, with selection bias classically precluding a fair comparison of outcomes between the transcranial approach (TCA) and endoscopic endonasal approach (EEA). The purpose of this systematic review was to analyze the current role of EEA in the treatment of pediatric CPs and to determine whether, upon expansion of its indications, a comparison with TCA is valid.A systematic review of English-language articles published between February 2010 and June 2022 was performed to identify studies in the MEDLINE (PubMed) and Embase databases reporting on the resection of pediatric CPs. Included were articles reporting on pediatric CPs removed through TCA or EEA. Case reports, review articles, and earlier or less comprehensive series by the same center were excluded. Baseline characteristics and outcomes were analyzed. Prediction intervals (PIs), heterogeneity (Q, I2, and τ2 statistics), and publication bias (funnel plot analysis) were assessed.A total of 835 patients underwent TCA (18 articles) and 403 patients underwent EEA (19 articles). Preoperatively, the mean patient age (p = 0.055, PI = 5.05-15.11), visual impairment (p = 0.08, PI = 19.1-90.5, I2 = 80%), and hypothalamic syndrome (p = 0.17, PI = 6.5-52.2, I2 = 62%) did not significantly differ between the EEA and TCA groups. Endocrine deficit (anterior pituitary deficit [p < 0.001, PI = 16.5-92.9, I2 = 81%] and diabetes insipidus [p < 0.001, PI = 6.3-60.6, I2 = 43%]) was more frequent in the EEA group. Hydrocephalus and signs/symptoms of raised intracranial pressure were significantly higher (p < 0.001, PI = 5.2-73.3, I2 = 70% vs p < 0.001, PI = 4.6-73, I2 = 62%, respectively) in the TCA group. Recurrent lesions (p = 0.52, PI = 2.7-87.3, I2 = 13%), tumor size (p = 0.25, PI = 22.1-56.8), third ventricle involvement (p = 0.053, PI = 10.9-81.3, I2 = 69%), and hypothalamic involvement (p = 0.06, PI = 8.5-83.6, I2 = 79%) did not differ significantly between the approaches. EEA was preferred (p = 0.006, PI = 26.8-70.8, I2 = 40%) for sellar-suprasellar CPs, whereas TCA was preferred for purely suprasellar CPs (p = 0.007, PI = 13.5-81.1, I2 = 61%). There was no difference between the approaches for purely intrasellar lesions (p = 0.94, PI = 0-62.7, I2 = 26%). The breadth of PIs, I2 values, and analysis of publication bias showed substantial variability among the pooled data, hindering the possibility of outcome meta-analyses.With the adoption of extended approaches, the use of EEA became appropriate for a wider spectrum of pediatric CPs, with associated excellent outcomes. Although a fair comparison between outcomes in the EEA and TCA groups was hindered because of the differences in patient populations and tumor subtypes, given the increased versatility of EEA and improved expertise in its use, surgeons can now select the optimal surgical approach based on the unique benefits and drawbacks of each pediatric CP.