Total removal of craniopharyngiomas

Abstract

The clinical features, perioperative course, and postoperative outcomes of 144 patients who underwent microsurgical resection of craniopharyngioma were reviewed. Overall, 90% of the tumors were completely resected and 7% recurred. Evaluation of those patients who underwent primary resection revealed much better results. The operative techniques and approaches are reviewed in detail. The results of this series suggest that primary total removal of craniopharyngiomas yields the best long-term outcome for the patient. Experience has shown that the larger the tumor the greater will be the damage, both preoperatively and intraoperatively, to vital intracranial structures. Consequently, early diagnosis, at a stage when the tumor is still small, improves the chances of accomplishing complete removal and of achieving good operative results. The early diagnosis of craniopharyngioma, before it can produce devastating neurological defects, continues to be the principal goal of our medical and pediatric colleagues.

Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke's pouch: impact on long-term prognosis

“…It is not clear whether the presence of HY constitutes a prognostic factor because both increased mortality (12) and lack of association with mortality have been reported (13,14,15,16). Our retrospective analyses of the thus far largest published cohort of long-term survivors of childhood-onset CP and CRP show that HY at diagnosis was not associated with reduced survival rates and impaired FC during long-term follow-up, supporting previous reports (13,14,15,16).…”

“…What remains unclear is whether the age at diagnosis represents a survival prognostic factor because some studies have demonstrated that the youngest patients have better survival rates (28,32,44), others have found better outcome in older patients (12,46), whereas still other studies report no difference between pediatric and adult populations (13,16,45,47). The role of sex as a prognostic factor is not established; some authors report a higher mortality among females (28,29), but others have not found any sex differences (13,15,16).…”

“…In the CP study of Yasargil et al (12), outcome (evaluated by deterioration of patient's general condition, dependence, endocrine replacement, and psycho-organic syndrome) was significantly compromised in patients with large tumors or HY or in those who underwent second or subsequent craniotomy for recurrence or uncontrolled growth of the original tumor. De Vile et al (26) suggested that severe HY, occurrence of intraoperative complications (vascular or frontal lobe trauma), and young age at presentation were predictors of poor longterm outcome.…”

“…Tumor size is likely to be a prognostic factor because increased survival rates have been shown in tumors with a diameter smaller than 3 cm (47). Several studies have described a more favorable prognosis when tumors lack calcification, especially in adult CP patients (12,47), although no specific pathological feature predicted survival in childhood CP patients (14). In other studies, neither tumor histology (16,47) nor tumor location (15,16) had prognostic importance.…”

“…Based on reports in the literature (12,13,14,15,16), it is not clear whether the presence of hydrocephalus (HY) constitutes a prognostic factor for long-term outcome in pediatric patients with sellar masses. The present retrospective study assessed the impact of HY, degree of resection, and tumor location at the time of diagnosis on survival and outcome in a large cohort of long-term survivors of these sellar masses.…”