Surgical Management of Craniopharyngioma with Large Calcification

Abstract

Background: Craniopharyngiomas with large diameter and major calcification are a particularly formidable challenge for radical resection. We report our surgical treatment and outcome of calcified and large craniopharyngiomas. Methods: From 1986 to 2013, 78 cases of craniopharyngiomas were resected at OCU hospital. There were 31 cases with 10% or more of calcification of tumor volume and 8 cases with 50% or more of calcification of tumor volume. In this study, we analyzed these eight cases retrospectively. Median age was 38.4 years (range 5-71 years). Four cases had been already received previous operation or radiotherapy at previous other hospitals. Five lesions underwent multistaged surgery for radical resection. Combined transpetrosal approach was selected in six cases, orbitozygomatic approach was selected in four cases, interhemispheric approach was selected in two cases, and extended transsphenoidal approach was selected in one case. During initial part of tumor resection, diamond drill or CUSA was used with the aim of division of calcification, and we resected tumor piece by piece. Results: Radical resection was performed in all cases. Visual function was improved in five cases and remained in three cases. Although one of eight patients died due to uncontrollable tumor progression, other patients show good functional outcome and good tumor control. Conclusions: Our policy of treatment of craniopharyngiomas is radical tumor resection even in cases with large calcification.