O5.06 * CYSTIC CRANIOPHARYNGIOMAS: MICROSURGICAL OR STEREOTACTIC TREATMENT?

Abstract

OBJECTIVE: The value of microsurgical and stereotactic treatment particularly in cystic craniopharyngiomas is poorly defined. We present outcome data in terms of functional results and progression free survival (PFS) after individualized treatment strategies: Solid tumors were considered eligible for open tumor resection, whereas predominantly cystic lesions were treated by stereotactic catheter placement for internal drainage. The target point for catheter implantation was the prepontine cisterne thereby enabling drainage in both directions the ventricular space (upstream) and the prepontine cisterne (downstream). METHODS: Patients with craniopharyngioma treated between 2001 and 2010 either by open tumor resection or stereotactic drainage were analyzed retrospectively. Reference point of the study was the date of surgical treatment. PFS was estimated with the Kaplan Meier method; prognostic factors were obtained from multivariate regression models including all relevant patient-, radiological-, and functional-related data. Adjuvant radiation therapy was used as second line treatment in case of unresectable recurrences. RESULTS: 68 consecutively treated patients (median age: 53 years) were included. Patients of the microsurgical (N = 44) and stereotactic group (N = 24) did not differ in terms of age, gender, tumor size, functional deficits, and duration of symptoms. Complete tumor resection and complete cyst drainage was obtained in 23/44 and 21/24 patients, respectively. Median PFS after surgical and stereotactic treatment was 51 months and 46 months, respectively (p = 0.1). Endocrinological outcome was significantly better after stereotactic treatment (p = 0.004). The overall transient complication rate was 4.4 % being lower in the stereotactic group (8.1 % vs. 0 %, p < 0.05). However, one patient of the stereotactic group experienced a haemorrhage leading to permanent morbidity (overall permanent morbidity rate: 1.5 %). CONCLUSIONS: For cystic craniopharyngiomas, stereotactic treatment (internal shunt) is safe and effective with very good preservation of the endocrinological function. This hypothesis requires further investigation in the framework of a prospective randomized study.