Abstract

Background:Craniopharyngiomas (CPs) are slow growing tumors with an incidence of between 1.2% and 4.6%, having a bimodal age distribution typically peaking in childhood and in adults between 45 and 60 years. Recurrences occur even after documented gross total resections necessitating a combination of therapeutic strategies. Obtaining a cure of this tumor in adults without producing major side effects continues to remain elusive.Methods:We describe our results in 11 patients with CP treated in a minimally invasive fashion using a combination of techniques like burr hole aspiration, Ommaya reservoir placement, ventriculo-peritoneal (VP) shunting and focal radiation (Gamma Knife stereotactic radiosurgery/Intensity modulated radiotherapy [GKRS/IMRT]).Results:Visual function remained intact in all patients; endocrine status remained stable with two patients developing new postoperative diabetes insipidus. There was no periprocedural morbidity or mortality, with hospital stays for any in-patient procedure being 48 hours or less.Conclusions:Minimally invasive techniques such as cyst aspiration, insertion of a catheter with Ommaya reservoir, when combined with stereotactic radiosurgery/IMRT is an effective and safe option for management and long-term control of adult CPs. We believe the Ommaya catheter by itself could act as a stent, creating a tract allowing gradual drainage of cyst fluid and stabilization without necessitating any further interventions in selected cases.

Highlights

  • Craniopharyngiomas (CPs) are slow growing tumors with an incidence of between 1.2% and 4.6%, having a bimodal age distribution typically peaking in childhood and in adults between 45 and 60 years

  • Craniopharyngiomas (CPs) are benign, slow growing tumors whose ideal management remains controversial and challenging. They arise from remnants of the craniopharyngeal duct and/or Rathkes cleft

  • These tumors have an incidence of between 1.2% and 4.6%[8,48] with a bimodal age distribution, one peak occurring in children and the other in adults between the 4th and 6th decades

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Summary

Objectives

The aim of this study was to present our outcomes treating adult CP patients using a combination of minimally invasive strategies including cyst aspiration, ventriculo-peritoneal (VP) shunting and either upfront or adjuvant conformal radiotherapy and a review of current literature

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