Abstract
Objective: This retrospective study aims to survey the clinical outcomes of 341 consecutive patients surgically treated for and diagnosed with craniopharyngioma (CP) treated in a 10-year period in a single institution. Methods: The clinical reports of three hundred forty-one patients CP patients treated surgically between January 2006 and December 2016 were reviewed and analyzed retrospectively. Results: Our cohort consisted of 341 patients (202 male, 139 female) with a mean age of 34.9 years (range 1 - 74 years); Tumor Features: 129 patients (37.8%) had cystic tumors, 88 (23.8%) had solid tumors whereas 126 (36.4%) had heterogeneous lesions with a solid and cystic portion; calcifications were present in 139 (40.8%); Tumor Topography: Suprasellar 198 (58.1%), Intrasellar 40 (11.7%), Intra-third ventricular 103 (30.2%); Surgical approaches used among the patients included: Pterional 262 (76.8%), Transsphenoidal (TS) 42 (12.3%) Transcallosal 20 (5.9%), Transcortical 16 (4.7%) suboccipital 1 and combined approach 1; Gross total removal (GTR) was achieved in 247 patients (72.4%), Subtotal removal (STR) in 94 patients (27.6%). Good postoperative outcome at discharge was achieved in 324 (95%) patients while 17 (5%) patients had poor outcome including 5 (1.5%) perioperative deaths. Mean hospital length of stay was 21.87 (8 - 129). There were 42 (12.9%) recurrences with a mean time to recurrence of 28.36 (3 - 84) months, among which 37 (88.1%) underwent surgery for recurrence treatment. Follow-up time ranged from 3 months to 10 years. There was a statistical significance between open transcranial surgery and suprasellar tumors (p < 0.0001), TS and intrasellar tumors (p < 0.0001); postoperative diabetes inspidus and gross total resection (p < 0.0001); GTR and cystic tumors (p = 0.034) calcification and GTR (p = 0.0008). Conclusion: Good surgical outcome and long-term tumor control can be achieved through individual-based selective resection, whether total or subtotal resection. Whereas surgical prehistory of CP was found to be a significant risk factor to recurrence (p < 0.0001), the clinical risk factors of CP of recurrence are still arguable, including the presence residual tumor due to subtotal resection. More future studies are necessary.
Highlights
Craniopharyngiomas (CPs) are benign tumors of the central nervous system [1] representing 1% of all the intracranial primary tumors which present with a challenging clinical and treatment sequala [2] [3] [4]
Our cohort consisted of 341 patients (202 male, 139 female) with a mean age of 34.9 years; Tumor Features: 129 patients (37.8%) had cystic tumors, 88 (23.8%) had solid tumors whereas 126 (36.4%) had heterogeneous lesions with a solid and cystic portion; calcifications were present in 139 (40.8%); Tumor Topography: Suprasellar 198 (58.1%), Intrasellar 40 (11.7%), Intra-third ventricular 103 (30.2%); Surgical approaches used among the patients included: Pterional 262 (76.8%), Transsphenoidal (TS) 42 (12.3%) Transcallosal 20 (5.9%), Transcortical 16 (4.7%) suboccipital 1 and combined approach 1; Gross total removal (GTR) was achieved in 247 patients (72.4%), Subtotal removal (STR) in 94 patients (27.6%)
CP surgery is one of the routine surgeries performed given the number of patients referred to our center with an average of 30 surgeries per year.A total of 341 patients treated between 2006 and 2016 were identified (Figure 2)
Summary
Craniopharyngiomas (CPs) are benign tumors of the central nervous system [1] representing 1% of all the intracranial primary tumors which present with a challenging clinical and treatment sequala [2] [3] [4]. The main challenge lies in preservation of normal function of the pituitary-hypothalamic axis following surgery [10] [12]. Early studies on craniopharyngioma began in 2008 with a smaller surgical series of 43 patients by Shu Kai et al [3] followed by a review ontreatment outcomes of transphenoidal (TS) approach for CPs by Lei Ting and associates [31] until recently followed by an update of 10 year review of TS approach for CP treatment in a cohort of 29 patients [2]
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