Surgical Strategies in Childhood Craniopharyngioma

Abstract

Craniopharyngiomas are biologically benign lesions (WHO Grade 1) of the sellar and suprasellar region, associated with a serious morbidity. About 50% of these tumors become clinically apparent during childhood. Clinical symptoms include headaches, chiasm syndrome, hydrocephalus, pituitary insufficiencies, and obesity. Growth arrest is a typical symptom in children. The treatment of craniopharyngiomas includes surgery as well as radiotherapy. The goal of surgery varies according to the tumor location and extension and may range from complete resection to biopsy. Surgical complications are well known and cause constant evaluation of surgical strategies. Diencephalic obesity is related to surgical manipulation of hypothalamic tissue. Therefore, a classification system for craniopharyngiomas based on preoperative MRI is suggested by the authors. Recurrences are frequent in craniopharyngiomas, even after complete or gross-total resection. Radiotherapy is therefore recommended to patients with incomplete resections. However, the ideal time for radiotherapy after surgery is under discussion. The treatment of craniopharyngiomas requires an interdisciplinary and multimodal approach. Each patient should receive an individually tailored treatment. Surgically, different approaches as well as different degrees of resection can be considered, depending on tumor location and tumor extension.

Childhood craniopharyngioma: treatment strategies and outcomes

“…With the aid of imaging studies, recent reports have indicated that the degree of obesity is positively correlated with the degree and extent of hypothalamic damage [39,[56][57][58]. Taking these considerations into account, a novel classification of pre-surgical involvement and post-surgical lesions of hypothalamic structures based on MRI was recently published [39,59]. The classification might help to establish more risk-adapted surgical strategies (FIGURE 2).…”

“…Depending on the tumor extension, section 2 can be reached by transcranial as well as transsphenoidal procedures. Modified with permission from [59], Frontiers Endocrinology. the prevalence of obesity is higher, reaching up to 55% [14,17,21,49,51,[61][62][63].…”

Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas

“…Craniopharyngiomas are classified as histologically benign tumors (WHO Grade 1 tumors) [1]. Nevertheless, the infiltrative behavior of the lesion may hamper its definitive treatment and often implies unfavorable and long-term sequelae after surgical removal [2].…”

Craniopharyngioma – Pediatric Management

“…For favorably localized childhood craniopharyngioma (i.e., without involvement of hypothalamic or optical structures), the treatment of choice is an attempt at complete resection with preservation of visual and hypothalamic function (Choux and Lena, 1979;Fahlbusch et al, 1999;Flitsch et al, 2011). For unfavorably localized tumors, which are too close to or too entangled with the optic nerve and/or the hypothalamus, controversy exists over whether complete resection should still be attempted, or whether a planned, limited resection (biopsy, partial/subtotal resection) should be performed (Muller, 2010a(Muller, , 2011aBuchfelder et al, 2013).…”