{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:47:17Z","timestamp":1767494837048,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To evaluate the cumulative summation (CUSUM) analysis of the learning curve for Endoscopic Endonasal Transsphenoidal resection of craniopharyngioma (EETC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospectively analyzed the clinical data of 113 patients who underwent EETC by the same neurosurgery team of the first affiliated Hospital of Nanchang University from June 2012 to November 2020. The learning curve was created by the CUSUM method and analyzed, which was divided into two groups: the learning stage and stable stage based on the learning curve trend. The median operation time and minimum surgical case number was calculated and the operation time and postoperative complications were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median operation time was 318\u2005min. The best fitting curve equation was <jats:italic>y<\/jats:italic>\u2009=\u2009227.72\u2009+\u200949.06<jats:italic>x<\/jats:italic>\u2009+\u20090.14<jats:italic>x<\/jats:italic><jats:sup>2\u2009<\/jats:sup>\u2212\u20090.05<jats:italic>x<\/jats:italic><jats:sup>3<\/jats:sup>, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.949, (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The minimum number of surgical cases was 65. Between the two groups, the operation time decreased from 360.8\u2009\u00b1\u2009106.4\u2005min in the learning group to 281.6\u2009\u00b1\u200969.9\u2005min in the stable group (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05). The incidence of postoperative complications (intracranial infection, cerebrospinal fluid rhinorrhea, and diabetes insipidus) was significantly reduced (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The CUSUM learning curve of craniopharyngioma resection via endoscope endonasal transsphenoidal approach could better describe the learning process for a neurosurgeon. The frequency of surgery could be a good factor for strengthening the learning effect and help to shorten the learning time. After 65 cases of EETC, the surgical skills can reach a stable stage, the operation time is obviously shortened, and the postoperative complications are significantly reduced.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2024.1146957","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T04:39:06Z","timestamp":1709095146000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cumulative summation analysis of learning curve for endoscopic endonasal transsphenoidal resection of craniopharyngiomas"],"prefix":"10.3389","volume":"11","author":[{"given":"Jiye","family":"Ye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiting","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunming","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1038\/s41572-019-0125-9","article-title":"Craniopharyngioma","volume":"5","author":"M\u00fcller","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"B2","first-page":"73","article-title":"Remarks on operative treatment of tumors of the hypophysis","volume":"28","author":"Halstead","year":"1910","journal-title":"Trans Am Surg Assoc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1001\/jamacardio.2017.0760","article-title":"Factors affecting the cost of airplanes and use of proprotein convertase subtilisin\/kexin type 9 inhibitors","volume":"2","author":"Stone","year":"2017","journal-title":"JAMA Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1136\/bmj.320.7228.171","article-title":"New surgical procedures: can we minimise the learning curve?","volume":"320","author":"Hasan","year":"2000","journal-title":"Br Med J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1002\/bjs.6056","article-title":"Quantitative and individualized assessment of the learning curve using LC-CUSUM","volume":"95","author":"Biau","year":"2008","journal-title":"Br J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2598","DOI":"10.1007\/s11695-022-06145-2","article-title":"Learning curve for laparoscopic sleeve gastrectomy: a cumulative summation (CUSUM) analysis","volume":"32","author":"Gil","year":"2022","journal-title":"Obes Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1080\/02656736.2022.2123566","article-title":"Evaluating the learning curve of high intensity focus ultrasound for breast fibroadenoma by CUSUM analysis: a multi-center study","volume":"39","author":"Xiao","year":"2022","journal-title":"Int J Hyperthermia"},{"key":"B8","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1007\/s11605-016-3105-3","article-title":"Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis","volume":"20","author":"Wang","year":"2016","journal-title":"J Gastrointest Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s00464-022-09549-4","article-title":"Learning curve of transoral robotic thyroidectomy","volume":"37","author":"Kim","year":"2023","journal-title":"Surg Endosc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"750","DOI":"10.3171\/2019.12.JNS192600","article-title":"How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases","volume":"134","author":"Younus","year":"2020","journal-title":"J Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.jocn.2017.04.021","article-title":"Learning curve for the endoscopic endonasal approach for suprasellar craniopharyngiomas","volume":"42","author":"Ding","year":"2017","journal-title":"J Clin Neurosci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2016.9.FOCUS16292","article-title":"The learning curve in endoscopic endonasal resection of craniopharyngiomas","volume":"41","author":"Kshettry","year":"2016","journal-title":"Neurosurg Focus"},{"key":"B13","doi-asserted-by":"publisher","first-page":"10215","DOI":"10.1038\/s41598-018-28282-4","article-title":"A novel endoscopic classification for craniopharyngioma based on its origin","volume":"8","author":"Tang","year":"2018","journal-title":"Sci Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1002\/lary.28943","article-title":"Functional results and learning curve of endoscopic stapes surgery: a 10-year experience","volume":"131","author":"Lucidi","year":"2021","journal-title":"Laryngoscope"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1017\/S0266462300103149","article-title":"Assessment of the learning curve in health technologies. A systematic review","volume":"16","author":"Ramsay","year":"2000","journal-title":"Int J Technol Assess Health Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/S0140-6736(74)92345-9","article-title":"Why don't doctors use cusums?","volume":"1","author":"Chaput de Saintonge","year":"1974","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1136\/pgmj.2007.057190","article-title":"Learning curves in surgical practice","volume":"83","author":"Hopper","year":"2007","journal-title":"Postgrad Med J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1002\/bjs.1800821117","article-title":"Cusum as an aid to early assessment of the surgical trainee","volume":"82","author":"Van Rij","year":"1995","journal-title":"Br J Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"483e1","DOI":"10.1016\/j.ajog.2019.05.037","article-title":"Learning curve of robot-assisted laparoscopic sacrocolpo(recto)pexy: a cumulative sum analysis","volume":"221","author":"van Zanten","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.gie.2020.09.023","article-title":"Evaluating learning curves and competence in colorectal EMR among advanced endoscopy fellows: a pilot multicenter prospective trial using cumulative sum analysis","volume":"93","author":"Yang","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2870","DOI":"10.1007\/s00464-020-07724-z","article-title":"Evaluation of a single surgeon\u2019s learning curve of laparoscopic pancreaticoduodenectomy: risk-adjusted cumulative summation analysis","volume":"35","author":"Kim","year":"2021","journal-title":"Surg Endosc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3442","DOI":"10.1007\/s00464-021-08665-x","article-title":"Cumulative summation analysis of learning curve for robotic-assisted hiatal hernia repairs","volume":"36","author":"Lin","year":"2022","journal-title":"Surg Endosc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1227\/00006123-199504000-00012","article-title":"Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches","volume":"36","author":"Maira","year":"1995","journal-title":"Neurosurgery"},{"key":"B24","doi-asserted-by":"publisher","first-page":"ONS75","DOI":"10.1227\/01.NEU.0000219897.98238.A3","article-title":"The endoscopic extended transsphenoidal approach for craniopharyngiomas","volume":"59","author":"Frank","year":"2006","journal-title":"Neurosurgery"},{"key":"B25","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.wneu.2011.07.011","article-title":"Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas","volume":"77","author":"Komotar","year":"2012","journal-title":"World Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1210\/er.2006-0002","article-title":"Craniopharyngiomas","volume":"27","author":"Hamblin","year":"2006","journal-title":"Endocr Rev"},{"key":"B27","doi-asserted-by":"publisher","first-page":"522","DOI":"10.3171\/2022.5.JNS212974","article-title":"Endoscopic endonasal approach for infradiaphragmatic craniopharyngiomas: a multicentric Italian study","volume":"138","author":"Solari","year":"2023","journal-title":"J Neurosurg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3171\/2019.3.JNS181953","article-title":"Clinical features and operative technique of transinfundibular craniopharyngioma","author":"Tang","year":"2019","journal-title":"J Neurosurg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"S199","DOI":"10.1055\/s-0038-1623527","article-title":"Extended endoscopic endonasal approach for craniopharyngioma removal","volume":"79","author":"Messerer","year":"2018","journal-title":"J Neurol Surg B Skull Base"},{"key":"B30","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1111\/joim.13261","article-title":"Diagnosis and management of diabetes insipidus for the internist: an update","volume":"290","author":"Christ-Crain","year":"2021","journal-title":"J Intern Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"448","DOI":"10.3171\/jns.2005.103.3.0448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut","year":"2005","journal-title":"J Neurosurg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.wneu.2017.04.047","article-title":"Clinical outcome after extended endoscopic endonasal resection of craniopharyngiomas: two-institution experience","volume":"103","author":"Park","year":"2017","journal-title":"World Neurosurg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"E5","DOI":"10.3171\/2012.V5.FOCUS11302","article-title":"Endoscopic endonasal craniopharyngioma resection","volume":"32","author":"Kenning","year":"2012","journal-title":"Neurosurg Focus"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1146957\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T04:39:13Z","timestamp":1709095153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1146957\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,28]]},"references-count":33,"alternative-id":["10.3389\/fsurg.2024.1146957"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2024.1146957","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2024,2,28]]},"article-number":"1146957"}}