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.

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    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.

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