Craniopharyngiomas in Children

Abstract

Forty-three children with craniopharyngiomas were operated upon at The Neurological Institute of New York between 1952 and 1977. The removal was thought to be total in 14 children and subtotal in 20, and cyst aspiration/biopsy was performed in 9 cases. Radiation was given as part of the initial therapy in 6 children after subtotal removal and to 8 others after aspiration/biopsy. There was 1 postoperative death. All children with tumors thought to have been removed totally are alive. The 10-year actuarial survival rates are 52% for subtotal removal alone and 87% for subtotal removal plus radiation. Tumors have recurred by 10 years in half of those thought to be totally removed, in more than 90% of those subtotally removed, and in less than 25% of those at risk after subtotal removal and radiation therapy. Tumors recurred in 22 children, and 17 underwent reoperation. Total removal was obtained in 4 cases, and 5 had radiation after subtotal removal. Radiotherapy alone was used in 2 cases. Recurrences usually occurred within 2 years. However, after "total" removal recurrences were quite delayed. Our data indicate that total removal allows excellent survival rates and that some of these children are potentially cured. The attempt at total removal did not inflict a severe hypothalamic or visual burden on these children. Where total removal is not possible, further therapy, either radiation or reoperation, will be required. Radiation dramatically decreased recurrence and improved survival after subtotal removal.

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

“…Postoperative morbidities include polyendocrinopathy and neurological dysfunction, including shunt dependence, seizures, and headaches. 13,21,101,106 Endocrine disorders, including panhypopituitarism, associated with aggressive tumor resection was considered "inevitable" and "acceptable." 76 Irreversible central diabetes insipidus and growth hormone deficiency after attempted GTR results in lifelong replacement therapy.…”

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

“…Various modified and combined pterional approaches to skull-base lesions have been reported [1][2][3][4][5][6][7] .…”

“…The pterional approach has been used in neurosurgery primarily for the treatment of a wide variety of neurosurgical disorders [1][2][3][4][5][6][7]11,33) . In vascular neurosurgery, in particular, pterional craniotomy exploits the advantages of naturally occurring planes and spaces that can be used to expose the base of the brain and the major structures of the circle of Willis, without significant brain retraction 14,19,25) .…”

Interstitial radiotherapy using phosphorus-32 for giant posterior fossa cystic craniopharyngiomas

“…21,30,34 Moreover, radical tumor resection cannot rule out the possibility of local tumor recurrence, even if postoperative MRI shows that no residual tumor remains. 4,5,7 Additionally, some long-term survivors after complete resection experience a poor quality of life. 8,12,17,19,20 Thus, partial resection associated with or without postoperative treatment has been proposed, including regular radiotherapy or interstitial radiotherapy, especially for tumors with hypothalamus involvement confirmed by preoperative imaging.…”

“…8,12,17,19,20 Thus, partial resection associated with or without postoperative treatment has been proposed, including regular radiotherapy or interstitial radiotherapy, especially for tumors with hypothalamus involvement confirmed by preoperative imaging. 5,7,8 Complete 1-stage resection of suprasellar and posterior fossa tumors through the Kawase approach has been reported as an effective surgical treatment, 11,18 although other studies have proposed multistage operations involving a craniotomy and resection of suprasellar tumors through the petrous and bilateral frontal region in the first stage.…”