Surgical treatment of craniopharyngiomas: experience with 168 patients

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Object. The goal of this study was to assess the outcome of surgical management in 168 consecutive patients harboring craniopharyngiomas treated between January 1983 and April 1997.

Methods. In 148 patients undergoing initial (primary) surgery, the pterional approach was most frequently used (39.2%), followed by the transsphenoidal approach (23.6%). For large retrochiasmatic craniopharyngiomas, the bifrontal interhemispheric approach was used increasingly over the pterional approach and led to improved surgical results. Total tumor removal was accomplished in 45.7% of transcranial and 85.7% of transsphenoidal procedures. The main reasons for incomplete removal were attachment to and/or infiltration of the hypothalamus, major calcifications, and attachment to vascular structures. The success rate in total tumor removal was inferior in the cases of tumor recurrence. The operative mortality rate in transcranial surgery was 1.1% in primary cases and 10.5% in cases of tumor recurrence. No patient died in the group that underwent transsphenoidal surgery. The rate of recurrence-free survival after total removal was 86.9% at 5 years and 81.3% at 10 years. In contrast, the 5-year recurrence-free survival rate was only 48.8% after subtotal removal and 41.5% after partial removal. Following primary surgery, the actuarial survival rate was 92.7% at 10 years, with the best results after complete tumor removal. At last follow up, 117 (79%) of 148 patients who underwent primary surgery were independent and without impairment.

Conclusions. Total tumor removal while avoiding hazardous intraoperative manipulation provides favorable early results and a high rate of long-term control in craniopharyngiomas.

Article Information

Address reprint requests to: Rudolf Fahlbusch, M.D., Department of Neurosurgery, University of Erlangen—Nürnberg, Schwabachanlage 6 (Kopfklinikum), 91054 Erlangen, Germany.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph depicting the age distribution of 148 patients with newly diagnosed craniopharyngioma.

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    Coronal and sagittal contrast-enhanced MR images obtained before (upper left and right) and after (lower left and right) removal of a craniopharyngioma by a combined, two-stage, transventricular—bifrontal-interhemispheric approach.

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    Coronal and sagittal contrast-enhanced MR images obtained in a patient who had a predominantly cystic craniopharyngioma. The images were obtained at presentation (upper left and right), after stereotactic cyst decompression (center left and right), and after removal of the solid portion and capsule by a pterional approach (lower left and right).

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    Graph depicting recurrence-free survival times in patients who underwent surgery for craniopharyngioma in relation to the extent of tumor resection (Kaplan-Meier method).

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    Upper: Graph displaying the actuarial survival curve of 148 patients who underwent primary surgery for craniopharyngioma. Lower: Graph showing survival times in patients who underwent primary surgery for craniopharyngioma in relation to the extent of tumor resection (Kaplan—Meier method).

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