Comparison of Outcomes following Primary and Repeat Resection of Craniopharyngioma

Abstract

Introduction The management of recurrent craniopharyngioma is complex with limited data to guide decision-making. Some reports suggest reoperation should be avoided due to an increased complication profile, while others have demonstrated that safe reoperation can be performed. For other types of skull base lesions, maximal safe resection followed by adjuvant therapy has replaced radical gross total resection due to the favorable morbidity profiles. Methods Seventy-one patients underwent resection over a 9-year period for craniopharyngioma and were retrospectively reviewed. Patients were separated into primary resection and reoperation cohorts and stratified by surgical approach (endonasal vs. cranial) and survival analyses were performed based on cohort and surgical approach. Results Fifty patients underwent primary resection, while 21 underwent reoperation for recurrence. Fifty endonasal transsphenoidal surgeries and 21 craniotomies were performed. Surgical approaches were similarly distributed across cohorts. Subtotal resection was achieved in 83% of all cases. There were no differences in extent of resection, visual outcomes, subsequent neuroendocrine function, and complications across cohorts and surgical approaches. The median time to recurrence was 87 months overall, and there were no differences by cohort and approach. The 5-year survival rate was 81.1% after reoperation versus 93.2% after primary resection. Conclusion Compared with primary resection, reoperation for craniopharyngioma recurrence is associated with similar functional and survival outcomes in light of individualized surgical approaches. Maximal safe resection followed by adjuvant radiotherapy for residual tumor likely preserves vision and endocrine function without sacrificing overall patient survival.

Craniopharyngioma surgery for rhinologists

“…For this reason, annual or biannual MRI scans are recommended for surveillance of recurrent tumor, as the majority of recurrences occur asymptomatically [49]. In regard to surgical intervention for management of recurrence, data is mixed, with some studies favoring positive outcomes with high rates of 5-year survival, up to 81%, for re-operation with adjuvant radiotherapy and others suggesting increased mortality rates with re-operation [50]. The wide variation in recurrence rates may be due to continually evolving operative techniques or due to differences in outcome based on anatomic tumor location; with the advent of predictive models, optimal therapy choice may be better selected using nomograms that utilize risk factors and patient-specific data, such as age, tumor subtype, extent of resection, involvement of the hypothalamus, and adjuvant radiotherapy [29,30 ▪ ].…”

Endoscopic endonasal transsphenoidal approach improves endocrine function and surgical outcome in primary craniopharyngioma resection: a systematic review and meta-analysis

“…It is well-accepted that there is a limitation of the methodology of statistical analysis in single-proportion meta-analysis, because a single-proportion meta-analysis commonly ignores the heterogeneity of the included study when pooling proportions and drawing conclusions, which might lead to a lack of interpretability and misleading conclusions [17][18][19]. Moreover, it is well-known that the clinical outcomes of the GTR rate, survival rate, pituitary hormone deficits, and incidence of hypothalamic-pituitary dysfunction disorders might be different between primary and repeat craniopharyngioma resection, whereas in these previous studies, the definition of the type of craniopharyngioma was not established (primary, recurrence or mixed) [20][21][22].…”