Treatments and Long-term Outcome of Craniopharyngiomas

Abstract

We have treated 61 patients during the past 16 years. With a review of the literature, we present epidemiology, selection of treatments, surgical approaches, radiation, postoperative management, and treatment of recurrent tumors, and discuss the required standard treatments and outcomes. Craniopharyngioma usually requires surgical resection or resection with radiotherapy (either conventional radiation or radiosurgery). In the literature, 10-year recurrence free survival rates were 47〜81% after total resection and 56〜84% after incomplete resection with radiation. However, 10-year survival rates of incomplete resection with radiation (65〜72%) were worse than those of total resection (92〜98%). Although total resection isideal, complications included surgical mortality (1〜2.5%), diabetes insipidus (79〜93%), hypopituitarism (79〜89%), and deterioration of visual function (15〜38%). Various surgical approaches could be selected. A transsphenoidal approach is suitable for intrasellar tumors or tumors with enlarged sella. A pterional approach is selected for relatively small tumors. Large or retrochiasmatic tumors require an anterior interhemispheric approach. Postoperative management of both the hypothalamus and any pituitary dysfunction is one of the important factors behind a good outcome. Recurrent tumors need surgical resection (ideally complete resection) or radiation therapy.