Gamma Knife Surgery for Residual or Recurrent Craniopharyngioma After Surgical Resection: A Multi-institutional Retrospective Study in Japan.

Takahiko Tsugawa,Seiko Hasegawa,Osamu Nagano,Hiroyuki Kenai,Tadashige Kano,Motohiro Hayashi,Shigeo Matsunaga,Tatsuya Kobayashi,Manabu Sato,Yoshiyasu Iwai,Yasushi Nagatomo,Shinji Onoue,Hisae Mori,Soichiro Yasuda,Masaaki Yamamoto,Toshinori Hasegawa,Akira Inoue

doi:10.7759/cureus.6973

Abstract

ObjectiveThe optimal treatment for a craniopharyngioma has been controversial. Complete resection is ideal, but it has been difficult to obtain total resection in many cases because of intimate proximity to critical structures such as the optic pathway, hypothalamus, and pituitary gland. A growing number of studies have demonstrated the utility of radiosurgery in controlling residual or recurrent craniopharyngioma. However, most of them are small series. The aim of this multi-institutional study was to clarify the efficacy and safety of Gamma Knife (Elekta, Stockholm, Sweden) surgery for patients with a craniopharyngioma.MethodsThis was a multi-institutional retrospective study by 16 medical centers of the Japan Leksell Gamma Knife Society. Data on patients with craniopharyngiomas treated with Gamma Knife Surgery (GKS) between 1991 and 2013 were obtained from individual institutional review board-approved databases at each center. A total of 242 patients with craniopharyngioma were included in this study. The mean age of the patients was 41 (range, 3 to 86) years. The median follow-up time was 61.4 months (range, 3 to 180 months). The mean radiosurgery target volume was 3.1 ml (range, 0.03-22.3 ml), and the mean marginal dose was 11.4 Gy (range, 8-20.4 Gy).ResultsTwo-hundred twenty patients were alive at the time of the last follow-up visit. The three-, five-, and 10-year overall survival rates after GKS were 95.4%, 92.5%, and 82.0%, respectively. The three-, five-, and 10-year progression-free survival rates after GKS were 73.1%, 62.2%, and 42.6% respectively. The rate of radiation-induced complications was 6.2%.ConclusionGKS is effective for controlling the tumor growth of craniopharyngiomas with an acceptable complication rate.

Highlights

Craniopharyngioma is a rare benign tumor thought to be derived from embryological remnants of the primitive craniopharyngeal duct or Rathke’s pouch
Data on patients with craniopharyngiomas treated with Gamma Knife Surgery (GKS) between 1991 and 2013 were obtained from individual institutional review board-approved databases at each center
We demonstrated the effectiveness of GKS for controlling residual and/or recurrent craniopharyngiomas, and, at the same time, showed the points to consider for achieving a better clinical course by this treatment strategy, namely, performing partial resection followed by GKS

Summary

Introduction

Craniopharyngioma is a rare benign tumor thought to be derived from embryological remnants of the primitive craniopharyngeal duct or Rathke’s pouch. Surgery is usually considered the treatment of choice. It offers rapid symptom relief and pathological confirmation, and when total resection is achieved, long-term local control can be expected [4]. Despite the advances in microsurgical and endoscopic techniques, it is difficult to achieve total resection in more than a few cases because of the intimate relationship with surrounding critical structures such as the hypothalamus, optic apparatus, and pituitary gland [5,6,7]. Several studies have reported the usefulness of Gamma Knife Surgery (GKS) for controlling craniopharyngiomas with a reduction in the complication rate; most have been small series [8,9,10,11,12,13,14]

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Discussion

Conclusion