Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997

Clinical article

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Object

The authors report surgical and endocrinological results of a series of 73 cases of craniopharyngioma that they treated surgically since 1997 to demonstrate their change in treatment strategy and its effect on outcome compared with a previous series and results reported in the literature.

Methods

A total of 73 patients underwent surgery for craniopharyngiomas between May 1997 and January 2005. In patients with poor clinical or neuropsychological condition, even following pretreatment, only stereotactic cyst aspiration took place (8 cases). In the remaining patients, gross-total resection (GTR) was intended and appeared to be possible. The most frequent approaches were subfrontal (27 cases) and transsphenoidal (26 cases); in some cases, a multistep approach was used. The rate of GTR, complications, and functional outcome (comparing pre- and postoperative endocrine and neuropsychological testing) were evaluated. The mean duration of follow-up was 25.2 months.

Results

Gross-total resection was achieved in 88.5% of cases in which a transsphenoidal approach was used and 79.5% of those in which a transcranial approach was used (85.2% of those in which a subfrontal approach was used and 72.7% of those in which a frontolateral approach was used). In the total series, GTR was achieved in 83.1% of cases (vs 49.3% in the authors' former series). The complication rate was 13.8% without any mortality. New endocrine deficits were observed more frequently in patients treated with transcranial approaches over the years (16.3%–66.7% vs 2.6%–50.0%) but were less frequent after transsphenoidal approaches (5.2%–19.2% vs 2.9%–45.7%).

Conclusions

Open surgery with intended total resection remains the treatment of choice in most patients. Initial stereotactic cyst aspiration or medical pretreatment to improve the patients' condition and adequate choice of surgical approach(es) are essential to achieve that goal. Nevertheless, a moderate increase in endocrinological deficits has to be accepted. The authors recommend using radiotherapy only in cases in which there are tumor remnants or disease progression after surgery.

Abbreviation used in this paper: GTR = gross-total resection.

Article Information

Address correspondence to: Rudolf Fahlbusch, M.D., International Neuroscience Institute, Rudolf Pichlmayrstrasse 4, 30625 Hannover, Germany. email: fahlbusch@ini-hannover.de.

Please include this information when citing this paper: published online September 23, 2011; DOI: 10.3171/2011.6.JNS081451.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Surgical strategy and decision-making algorithm for the treatment of craniopharyngiomas.

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    Criteria for choice of adequate approach, showing tumor extension according to MR imaging (upper row) and the corresponding approaches (lower rows).

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    Endocrine function in patients undergoing transsphenoidal surgery (January 1983–April 1997 vs May 1997–January 2005). Left: Comparison of pre- and postoperative rates of endocrine deficits. Right: Incidence of new endocrine deficiencies following surgery. Cor = cortisol; DI = diabetes insipidus; GON = gonadotropins; PRL = prolactin; TSH = thyroid stimulating hormone.

  • View in gallery

    Endocrine function in patients undergoing transcranial surgery (January 1983–April 1997 vs May 1997–January 2005). Left: Comparison of pre- and postoperative rates of endocrine deficits. Right: Incidence of new endocrine deficiencies following surgery.

  • View in gallery

    Endocrine function in patients treated via different transcranial approaches. Left: Comparison of pre- and postoperative endocrine deficiencies in patients treated via subfrontal and frontolateral approaches. Right: Incidence of new endocrine deficiencies stratified by approach. DI = diabetes insipidus; COR = cortisol; TSH = thyroid stimulating hormone; GON = gonadotropins; PRL = prolactin; GH = growth hormone.

References

  • 1

    Abe TLüdecke DK: Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients. Neurosurgery 44:9579661999

  • 2

    Baskin DSWilson CB: Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg 65:22271986

  • 3

    Bülow BAttewell RHagmar LMalmström PNordström CHErfurth EM: Postoperative prognosis in craniopharyngioma with respect to cardiovascular mortality, survival, and tumor recurrence. J Clin Endocrinol Metab 83:389739041998

    • Search Google Scholar
    • Export Citation
  • 4

    Caldarelli MMassimi LTamburrini GCappa MDi Rocco C: Long-term results of the surgical treatment of craniopharyngioma: the experience at the Policlinico Gemelli, Catholic University, Rome. Childs Nerv Syst 21:7477572005

    • Search Google Scholar
    • Export Citation
  • 5

    Chakrabarti IAmar APCouldwell WWeiss MH: Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102:6506572005

    • Search Google Scholar
    • Export Citation
  • 6

    Chen COkera SDavies PESelva DCrompton JL: Craniopharyngioma: a review of long-term visual outcome. Clin Experiment Ophthalmol 31:2202282003

    • Search Google Scholar
    • Export Citation
  • 7

    Chen CJ: Suprasellar and infrasellar craniopharyngioma with a persistent craniopharyngeal canal: case report and review of the literature. Neuroradiology 43:7607622001

    • Search Google Scholar
    • Export Citation
  • 8

    Chung WYPan DHShiau CYGuo WYWang LW: Gamma knife radiosurgery for craniopharyngiomas. J Neurosurg 93:Suppl 347562000

  • 9

    Duff JMMeyer FBIlstrup DMLaws ER JrSchleck CDScheithauer BW: Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46:2913052000

    • Search Google Scholar
    • Export Citation
  • 10

    Fahlbusch RBuchfelder MTests of endocrine function for neurosurgical patients. Crockard AHayward RHoff JT: Neurosurgery: The Scientific Basis of Clinical Practice ed 3Malden, MABlackwell Science2000. 1:936945

    • Search Google Scholar
    • Export Citation
  • 11

    Fahlbusch RHofmann BM: Surgical management of giant craniopharyngiomas. Acta Neurochir (Wien) 150:121312262008

  • 12

    Fahlbusch RHonegger JPaulus WHuk WJBuchfelder M: Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:2372501999

    • Search Google Scholar
    • Export Citation
  • 13

    Fischer EGWelch KShillito J JrWinston KRTarbell NJ: Craniopharyngiomas in children. Long-term effects of conservative surgical procedures combined with radiation therapy. J Neurosurg 73:5345401990

    • Search Google Scholar
    • Export Citation
  • 14

    Fisher PGJenab JGopldthwaite PTTihan TWharam MDFoer DR: Outcomes and failure patterns in childhood craniopharyngiomas. Childs Nerv Syst 14:5585631998

    • Search Google Scholar
    • Export Citation
  • 15

    Gonc ENYordam NOzon AAlikasifoglu AKandemir N: Endocrinological outcome of different treatment options in children with craniopharyngioma: a retrospective analysis of 66 cases. Pediatr Neurosurg 40:1121192004

    • Search Google Scholar
    • Export Citation
  • 16

    Hasegawa TKondziolka DHadjipanayis CGLunsford LD: Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 54:8138222004

    • Search Google Scholar
    • Export Citation
  • 17

    Hoffman HJ: Surgical management of craniopharyngioma. Pediatr Neurosurg 21:Suppl 144491994

  • 18

    Hoffman HJDe Silva MHumphreys RPDrake JMSmith MLBlaser SI: Aggressive surgical management of craniopharyngiomas in children. J Neurosurg 76:47521992

    • Search Google Scholar
    • Export Citation
  • 19

    Honegger JBuchfelder MFahlbusch R: Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg 90:2512571999

    • Search Google Scholar
    • Export Citation
  • 20

    Honegger JBuchfelder MFahlbusch RDäubler BDörr HG: Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37:1891961992

    • Search Google Scholar
    • Export Citation
  • 21

    Isaac MAHahn SSKim JABogart JAChung CT: Management of craniopharyngioma. Cancer J 7:5165202001

  • 22

    Julow JBacklund EOLányi FHajda MBálint KNyáry I: Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas. Neurosurgery 61:2882962007

    • Search Google Scholar
    • Export Citation
  • 23

    Julow JLányi FHajda MSzeifert GTViola ABálint K: Stereotactic intracavitary irradiation of cystic craniopharyngiomas with yttrium-90 isotope. Prog Neurol Surg 20:2892962007

    • Search Google Scholar
    • Export Citation
  • 24

    Karavitaki NBrufani CWarner JTAdams CBRichards PAnsorge O: Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 62:3974092005

    • Search Google Scholar
    • Export Citation
  • 25

    Karavitaki NCudlip SAdams CBWass JA: Craniopharyngiomas. Endocr Rev 27:3713972006

  • 26

    Kato TSawamura YAbe HNagashima M: Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir (Wien) 140:7157191998

    • Search Google Scholar
    • Export Citation
  • 27

    Kobayashi TKida YHasegawa T: Long-term results of gamma knife surgery for craniopharyngioma. Neurosurg Focus 14:5e132003

  • 28

    Kobayashi TTanaka TKida Y: Stereotactic gamma radiosurgery of craniopharyngiomas. Pediatr Neurosurg 21:Suppl 169741994

  • 29

    Larijani BBastanhagh MHPajouhi MKargar Shadab FVasigh AAghakhani S: Presentation and outcome of 93 cases of craniopharyngioma. Eur J Cancer Care (Engl) 13:11152004

    • Search Google Scholar
    • Export Citation
  • 30

    Laws ER Jr: Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:6616661980

  • 31

    Laws ER Jr: Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 21:Suppl 157631994

  • 32

    Lehrl S: Mehrfachwahl-Wortschatz-Intelligenztest (MWTB) BalingenPerimed-spitta1995

  • 33

    Maira GAnile CAlbanese ACabezas DPardi FVignati A: The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg 100:4454512004

    • Search Google Scholar
    • Export Citation
  • 34

    Maira GAnile CRossi GFColosimo C: Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 36:7157241995

    • Search Google Scholar
    • Export Citation
  • 35

    Miller DC: Pathology of craniopharyngiomas: clinical import of pathological findings. Pediatr Neurosurg 21:Suppl 111171994

  • 36

    Mokry M: Craniopharyngiomas: a six year experience with Gamma Knife radiosurgery. Stereotact Funct Neurosurg 72:Suppl 11401491999

  • 37

    Nimsky CGanslandt OHofmann BFahlbusch R: Limited benefit of intraoperative low-field magnetic resonance imaging in craniopharyngioma surgery. Neurosurgery 53:72812003

    • Search Google Scholar
    • Export Citation
  • 38

    Norris JSPavaresh MAfshar F: Primary transsphenoidal microsurgery in the treatment of craniopharyngiomas. Br J Neurosurg 12:3053121998

    • Search Google Scholar
    • Export Citation
  • 39

    Pereira AMSchmid EMSchutte PJVoormolen JHBiermasz NRvan Thiel SW: High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf) 62:1972042005

    • Search Google Scholar
    • Export Citation
  • 40

    Poretti AGrotzer MARibi KSchönle EBoltshauser E: Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol 46:2202292004

    • Search Google Scholar
    • Export Citation
  • 41

    Regine WFMohiuddin MKramer S: Long-term results of pediatric and adult craniopharyngiomas treated with combined surgery and radiation. Radiother Oncol 27:13211993

    • Search Google Scholar
    • Export Citation
  • 42

    Reitan RMHerring S: A short screening device for identification of cerebral dysfunction in children. J Clin Psychol 41:6436501985

    • Search Google Scholar
    • Export Citation
  • 43

    Sanford RA: Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery. Pediatr Neurosurg 21:Suppl 139431994

    • Search Google Scholar
    • Export Citation
  • 44

    Shirane RChing-Chan SKusaka YJokura HYoshimoto T: Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern: an evaluation of the frontobasal interhemispheric approach. J Neurosurg 96:7047122002

    • Search Google Scholar
    • Export Citation
  • 45

    Steno JMalácek MBízik I: Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 54:105110602004

    • Search Google Scholar
    • Export Citation
  • 46

    Úlfarsson ELindquist CRoberts MRähn TLindquist MThorén M: Gamma knife radiosurgery for craniopharyngiomas: long-term results in the first Swedish patients. J Neurosurg 97:5 Suppl6136222002

    • Search Google Scholar
    • Export Citation
  • 47

    Van Effenterre RBoch AL: Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3112002

  • 48

    Villani RMTomei GBello LSganzerla EAmbrosi BRe T: Long-term results of treatment for craniopharyngioma in children. Childs Nerv Syst 13:3974051997

    • Search Google Scholar
    • Export Citation
  • 49

    Wechsler D: Manual for the Wechsler Adult Intelligence Scale-Revised (WAIS-R) San AntonioPsychological Corporation1981

  • 50

    Weiner HLWisoff JHRosenberg MEKupersmith MJCohen HZagzag D: Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 35:100110111994

    • Search Google Scholar
    • Export Citation
  • 51

    Xu XShigemori M: Microsurgical management of craniopharyngiomas—outcomes in 56 patients. Kurume Med J 45:53571998

  • 52

    Yaşargil MGCurcic MKis MSiegenthaler GTeddy PJRoth P: Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73:3111990

    • Search Google Scholar
    • Export Citation
  • 53

    Zhao RDeng JLiang XZeng JChen XWang J: Treatment of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Childs Nerv Syst 26:6696742010

    • Search Google Scholar
    • Export Citation
  • 54

    Zhou ZQShi XE: Changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas. Chin Med J (Engl) 117:3573602004

    • Search Google Scholar
    • Export Citation

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