Surgery For Craniopharyngioma Research Articles

Use of moderate hypofractionated radiotherapy in craniopharyngioma

External beam radiation therapy is used for inoperable, residual, or recurrent disease after surgery for craniopharyngioma. At present, conventional radiotherapy, hypofractionated radiotherapy (HFRT), and stereotactic radiotherapy (SRT) are available options. However, there are limited data on HFRT and SRT using modern radiotherapy (RT) devices. This paper presents the findings of a retrospective study conducted at a single institution based on our long-term experiences with eight craniopharyngioma patients who had underwent RT. The median time between the operation and RT was 8.5 months (ranging from 2.6 to 11 months). Six patients were treated with CyberKnife® (CK®), and two were treated with Tomotherapy® (HT®) using the helical intensity-modulated RT technique (H-IMRT). Patients treated with HT received a mean of 50 and 55 Gy RT in 25 and 30 fractions (conventional RT scheme), respectively. Out of the six patients treated with CK, three received a mean of 22 – 25 Gy in five fractions, and the other three received a mean of 40 – 42 Gy in 15 fractions. The median follow-up was 6 years (range: 2 – 9.1 years), and no progression was observed. The 3-year overall survival (OS) and progression-free survival (PFS) rates were 85.7% and 85.7%, respectively. OS and PFS at 5 years were likewise 85.7% and 85.7%, respectively. Of the two patients (25%) who were alive with a complete response, one received 50 Gy in 25 fractions with H-IMRT, and the other received RT through CyberKnife with five fractions. Five patients (62.5%) were alive with stable residual disease and one patient had died with a complete response. HFRT may be considered as a preferable option in the treatment of craniopharyngioma, in addition to conventional or SBRT treatment options.

Serum sodium level fluctuations following the resection of childhood-onset craniopharyngioma.

Craniopharyngiomas are low-grade malignancies (WHO I) in the sellar region. Most cases of childhood-onset craniopharyngioma are adamantinomatous craniopharyngioma, and neurosurgery is the treatment of choice. Affected patients have postoperative complications, including water and electrolyte disturbances, because these malignancies develop near the hypothalamus and pituitary gland. Determining postoperative serum sodium fluctuation patterns in these patients can reduce postoperative mortality and improve prognosis. To measure changes in serum sodium levels in pediatric patients who underwent craniopharyngioma surgery and identify influencing factors. This retrospective study measured the serum sodium levels of 202 patients aged 0-18 years who underwent craniopharyngioma resection in Beijing Tiantan Hospital and Beijing Children's Hospital and identified predictors of severe hyponatremia and hypernatremia. The mean age of the cohort was 8.35±4.35 years. The prevalence of hypernatremia, hyponatremia, and their severe forms (serum Na+ >150mmol/L and serum Na+ <130mmol/L) within 14 days after surgery was 66.3%, 72.8%, 37.1%, and 40.6%, respectively. The mean postoperative serum sodium level showed a triphasic pattern, characterized by two peaks separated by a nadir. Sodium levels peaked on days 2 (143.6±7.6mmol/L) and 14 (143.2±6.7mmol/L) and reached their lowest on day 6 (135.5±7.5mmol/L). A total of 31 (15.3%) patients met the diagnostic threshold for hyponatremia and hypernatremia of the triphase response, whereas 116 (57.4%) patients presented this pattern, regardless of met the diagnostic criteria or not. The prevalence of severe hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach. Serum sodium levels after craniopharyngioma resection in children showed a triphasic pattern in most cases. The risk of postoperative hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach.

Long-Term Outcomes in Pediatric Midfacial Growth Following Expanded Endonasal Skull Base Surgery for Craniopharyngioma.

Long-Term Outcomes in Pediatric Midfacial Growth Following Expanded Endonasal Skull Base Surgery for Craniopharyngioma.

Delayed cerebral vasospasm following craniopharyngioma surgery: The impact of the electrolytes imbalance

Cerebral vasospasm is a well-known phenomenon following aneurysmal subarachnoid hemorrhage and trauma. While cerebral vasospasm is observed following skull base tumor surgery, it remains a rare phenomenon and is a major cause of neurologic morbidity and mortality [1,2].

Neuroendoscopy: history, endoscopes, and instrumentation.

Endoscopy was first employed in the surgical treatment of neurosurgical diseases early in the twentieth century, but did not become an established practice for a long time, mainly because of poor technology and clinical results. After a slow re-appearance in the 1980s, the 1990s saw an explosion of techniques and instrumentation. Continuing technological improvement has led to further expansion of surgical techniques and indications for use of neuroendoscopy. The expansion of ventricular endoscopy has led to significant understanding of CSF disorders. Aqueduct stenosis as cause of hydrocephalus and arachnoid cysts are an example of pathologies, the concept and understanding of which now is considerably enhanced, due to the application of neuroendoscopy in their treatment. Management of loculated hydrocephalus has been facilitated considerably with the use of the endoscope. The concepts of aqueductoplasty, septostomy, and foraminoplasty of the foramina of Monro and Magendie emerged, which were previously unknown. Skull base surgery, especially surgery for craniopharyngioma, has seen dramatic improvement in results with the use of the endoscope. Coupling of the endoscope with neuronavigation has expanded technical capabilities even further. Overall, we can do a lot more with the endoscope now in comparison to 30years ago. We should always remember that the endoscope is only a tool. Its use has indications and limitations related to its design and our ability to extract the maximum, in the context of its shortcomings. Further technological advances will push surgical frontiers even more in years to come.

Early post-operative diabetes insipidus following resection of craniopharyngioma: Incidence and predictors

ObjectiveCraniopharyngiomas are tumors derived from the remains of epithelial cells that are attributed to incomplete closure of the pituitary or cricopharyngeal ducts. Although the tumor is considered benign, it has significant complications at diagnosis and following full resolution. The present study aimed to determine the prevalence and predictive factors of diabetes insipidus (DI) shortly after craniopharyngioma surgery. MethodsThis study was retrospectively performed on 46 patients suffering from craniopharyngioma referred to Loghman Hakim Hospital sparing from 2011 to 2016. In patients with magnetic resonance imaging (MRI) and computerized tomography (CT) scans, endocrinology tests, other related tests, and complete neuromuscular examinations were performed before and after surgery. All patient information was collected descriptively according to their case, and quantitative data are displayed using mean, Standard Deviation, intermediate, and Interquartile range, and qualitative data are displayed using frequency and percentage. For analytical analysis, the data were calculated from independent samples t, Mann-Whitney statistical tests, K2 test, and, if necessary, Fisher's precise P-Value. A significant level was considered for the 5 % statistical tests, and the SPSS statistical software version 25 was used to analyze the data. ResultsMost patients were male (58 %), and the mean age of patients was 33 years, the youngest being 5 years and the oldest being 71 years. Patients' symptoms at the time of referral include visual impairment (58 %), headache (56 %), balance disorder 19 %, nausea and vomiting 13 %, and memory impairment (8 %). The prevalence of DI was reported to be 50 % after surgery, significantly associated with tumor size. No other significant association was found between the plurality of DI after surgery and other variables studied. ConclusionsThe present study showed no predictive factor for post-operative DI in patients with craniopharyngioma. It can only be concluded that patients with larger tumor sizes are more likely to develop DI; however, more studies are warranted to achieve a definitive conclusion.

The feasibility and acceptability of mobile ecological momentary assessment to evaluate sleep, family functioning, and affect in patients with pediatric craniopharyngioma

Purpose/Objectives We aimed to assess the feasibility and acceptability of mobile ecological momentary assessment (mEMA) for youth with craniopharyngioma and evaluate daily associations among family functioning, affect, and sleep difficulties. Design/Research Approach Youth completed two mEMA diaries per day for one week. Sample/Participants Thirty-nine youth who underwent surgery and proton radiotherapy (when indicated) for craniopharyngioma. Methods/Methodological Approach Descriptive statistics and multi-level modeling were used to examine feasibility and acceptability of mEMA and daily associations among family functioning, affect, and sleep. Findings Youth reported satisfaction and minimal burden from completing daily mEMA diaries. Poorer family functioning was not related to lower sleep efficiency. Conclusions/Interpretation mEMA is an acceptable and feasible method for evaluating sleep and related variables in children and adolescents with craniopharyngioma. Implications for Psychosocial Providers or Policy Results highlight the utility of gathering mEMA data in youth at elevated risk for sleep difficulties as a function of their illness/treatment.

Surgical Approaches to Craniopharyngiomas

Surgical treatment of craniopharyngioma still presents several challenges. The tumor recurs at a high rate when its removal is insufficient. However, total resection of the tumor has a high risk of complications owing to its proximity to the hypothalamus and the pituitary stalk. In addition, tumor control by radiation treatment is insufficient for long follow-up periods of over 10 years. Therefore, various treatments have been selected, ranging from partial tumor removal followed by radiation to total tumor removal, even if it involves sacrificing pituitary functions. In this article, we explain the surgical treatment with a focus on endoscopic endonasal surgery for craniopharyngiomas.

Low- and Negative-Pressure Hydrocephalus: New Report of Six Cases and Literature Review.

Low- or very-low-pressure hydrocephalus is a serious and rare phenomenon, which is becoming better known since it was first described in 1994 by Pang and Altschuler. Forced drainage at negative pressures can, in most cases, restore the ventricles to their original size, thus achieving neurological recovery. We present six new cases that suffered this syndrome from 2015 to 2020: two of them after medulloblastoma surgery; a third one as a consequence of a severe head trauma that required bifrontal craniectomy; another one after craniopharyngioma surgery; a fifth one with leptomeningeal glioneuronal tumor; and, finally, a patient with a shunt for normotensive hydrocephalus. Before the development of this condition, four of them had mid-low-pressure cerebrospinal fluid (CSF) shunts. Four patients required cerebrospinal fluid (CSF) drainage at negative pressures oscillating from zero to -15 mmHg by external ventricular drainage until ventricular size normalized, followed by the placement of a new definitive low-pressure shunt, one of them to the right atrium. The duration of drainage in negative pressures through external ventricular drainage (EVD) ranged from 10 to 40 days with concomitant intracranial pressure monitoring at the neurointensive care unit. Approximately 200 cases of this syndrome have been described in the literature. The causes are varied and superimposable to those of high-pressure hydrocephalus. Neurological impairment is due to ventricular size and not to pressure values. Subzero drainage is still the most commonly used method, but other treatments have been described, such as neck wrapping, ventriculostomy of the third ventricle, and lumbar blood patches when associated with lumbar puncture. Its pathophysiology is not clear, although it seems to involve changes in the permeability and viscoelasticity of the brain parenchyma together with an imbalance in CSF circulation in the craniospinal subarachnoid space.

Predictors of the Spontaneous Resolution of Central Diabetes Insipidus Following Endoscopic Endonasal Surgery for Craniopharyngioma.

Central diabetes insipidus (CDI) is the most common complication of endoscopic endonasal surgery (EES) for craniopharyngioma. However, some cases of CDI could spontaneously resolve during the follow-up period. Hence, this study aimed to determine the predictive factors for the spontaneous resolution of CDI. Data of patients with CDI who underwent EES for craniopharyngioma between February 2009 and June 2021 were retrospectively reviewed. All patients were divided into 2 groups based on the resolution of CDI during follow-up: the recovery and no recovery groups. The baseline characteristic, surgical, and follow-up results of patients were compared. We identified 84 patients with CDI (35 in the recovery group and 49 in the no recovery group). A direct comparison showed that retaining the pituitary stalk (57.1% vs. 14.3%, P= 0.000) and no-hypothalamic injury (HI) (68.6% vs. 20.4%, P= 0.000) were more common in the recovery group, whereas hydrocephalus at diagnosis (8.6% vs. 46.9%, P= 0.000) was significantly more common in the no recovery group. Subsequently, we found through univariate and multivariate analysis that the spontaneous resolution of CDI was associated with hydrocephalus at diagnosis (yes vs. no: odds ratio [OR], 0.198; P= 0.045), pituitary stalk injury (retaining vs. sectioning: OR, 7.055; P= 0.004), and the Hong etal HI pattern (mild-HI vs. no-HI: OR, 0.183; P= 0.038; unilateral-HI vs. no-HI: OR, 0.147; P= 0.017; bilateral-HI vs. no-HI: OR, 0.154; P= 0.044). Hydrocephalus at diagnosis, pituitary stalk injury, and the Hong etal HI pattern might be predictors of the spontaneous resolution of CDI following EES for craniopharyngioma.

Endoscopic endonasal approach for craniopharyngiomas in children

Background. The incidence of craniopharyngiomas is up to 15 % of intracranial tumors in children. The endoscopic endonasal approach (EEA) is widely spread nowadays and especially for the craniopharyngiomas removal in adults. Nevertheless, this approach is still not so common in pediatric patients. The endoscopic technique significantly improves the visualization of the structures located around the tumor.Aim. To determine the possibilities and limitations for the use of EEA in the treatment of pediatric patients with cranio pharyngiomas.Materials and methods. A total five pediatric patients with craniopharyngiomas were operated via EEA Federal Center of Neurosurgery of Ministry of Health of Russia (Novosibirsk): the age of patients ranged from 4 to 17 years, including 3 boys and 2 girls. All patients at the preoperative stage already had endocrine disorders in one volume or another. Postoperative evaluation of the visual functions showed the improvement in one patient, three patients remained unchanged and one patient developed worthening. In addition, the volume of the sphenoid sinus was studied, the degree of pneumatization of which determines the anatomical accessibility of the tumor.Results. Our experience of the EEA for the craniopharyngiomas in pediatric patients has shown a positive result regarding to the tumor’s gross‑total removal and no data of the tumor recurrence at the follow‑up. According to our results it can be judged that endonasal endoscopic approach for the craniopharyngiomas in pediatric patients could be a method of choice based on the anatomical accessibility of the tumor and its relationships with the critical neurovascular structures.Conclusions. Endoscopic endonasal removal of craniopharyngiomas in pediatric patients can be successfully used when the tumor is anatomically accessible. The experience of using EED in surgery for craniopharyngiomas in children has shown positive results, including a high radical removal of the tumor and the absence of relapses during further follow‑up of patients.

Benefits and risks evaluation of recombinant human growth hormone replacement therapy in children with GHD after craniopharyngioma surgery.

Childhood-onset craniopharyngiomas (CPs) have a high incidence of growth hormone deficiency (GHD) leading to growth failure and metabolic disorders. We aim to evaluate the benefits and risks of recombinant human growth hormone replacement therapy (GHRT) in postoperative children. We retrospectively analyzed auxological and metabolic parameters and adverse events before and after GHRT of 44 children after CP surgery. The median duration of GHRT was 24months (IQR, 12.5-36). Growth velocity (GV) increased significantly after different treatment duration (TD) compared with baseline (p<0.001) and attained the greatest GV of 12.06±4.16cm/year at TD6. The mean height standard deviation score (HtSDS) from-3.20±1.16at baseline improved significantly to-1.51±1.32 at TD36 (p<0.001). There were significant increases in insulin-like growth factor-1 SDS (IGF-1SDS), insulin-like growth factor binding protein 3 SDS (IGFBP-3SDS), bone age (BA), and BA/chronological age (CA) (p<0.05). There was a significant reduction in waist-to-hip ratio (WHR), but there were no significant changes in weight SDS (WtSDS) or BMISDS. Low-density lipoprotein-cholesterol (LDL-C) levels and the incidence of hypercholesterolemia decreased (p<0.05). Three patients (6.8%) had tumor recurrence after 15, 30, and 42months, respectively. A patient had residual tumor enlargement after 3months. There was no adverse influence on glucose metabolism or any severe adverse events. GHRT effectively accelerates GV, increases HtSDS, and improves lipid profiles without unfavorable effects on glucose metabolism. The benefits are clear and the risks of adverse events are low.

Anesthesia management in a pediatric patient with craniopharyngioma

Craniopharyngiomas are the most common sellar or suprasellar tumors in childhood. The most critical issue in neuro anesthesia is to ensure adequate cerebral perfusion pressure and appropriate surgical conditions without disturbing the autoregulation of the cerebral circulation. The purpose of this article is to provide an overview of anesthetic management in successful craniopharyngioma surgery in pediatric patients. The purpose of this article is to provide an overview of anesthetic management in successful craniopharyngioma surgery in pediatric patients. Transsphenoidal pituitary surgery was planned. The patient, who had no intraoperative complications, was extubated postoperatively and transferred to the intensive care unit for close monitoring. Non-invasive monitoring (pulse oximetry, ECG, blood pressure, and temperature monitoring) was performed. A precordial USG was prepared to detect air embolism. Moderate hypothermia of 34-36°C was achieved. The patient, who had no intraoperative complications, was extubated postoperatively and transferred to the intensive care unit for close monitoring. The goals of anesthesia for transsphenoidal pituitary surgery include optimizing cerebral oxygenation, maintaining hemodynamic stability, managing intraoperative complications, and facilitating a rapid and smooth recovery.

Transnasal endoscopic surgery of craniopharyngiomas in children

Transnasal endoscopic surgery of craniopharyngiomas in children

Qualitative descriptive study during the COVID-19 pandemic on the needs of informal caregivers of Chinese minors who underwent craniopharyngioma surgery

PurposeTo determine the needs of informal caregivers during the long-term health management of minors who have undergone craniopharyngioma surgery.Design and methodologyThis is a qualitative and descriptive research study. Purposive sampling was used to select participants, and semi-structured interviews were conducted to explore the needs of 21 informal caregivers for postoperative minors. Due to the COVID-19 pandemic, the respondents were provided with the options of online video call or offline one-on-one interviews. Following this, a content analysis method was conducted. ResultsFour themes and 14 sub-themes were extracted from the results of the study, including needs for relieving psychological stress (including psychological pressure on both minors and on caregivers); requirement for on-campus assistance (physical activity, eliminating verbal violence in schools, special education needs for child, healthcare services provided by school hospitals); demands for medical help (acquiring medical knowledge, need for medication management, convenience and reliable access to medical services, need for technological development, expectations of multidisciplinary cooperation, the necessity of health review reminders); and the desire for financial aid (charity platform assistance, inclination of government policy). ConclusionsIn China, informal caregivers of young patients with onset craniopharyngioma require both the multidisciplinary cooperation of medical institutions and the multi-departmental cooperation of society. Information and medical technology advancements may benefit families with young patients. Improving community hospitals' medical services and encouraging the practical use of online medical treatment and prescriptions are both necessary in the context of COVID-19. Practice implicationsBy identifying the needs of informal caregivers, medical professionals are able to develop care plans and interventions aimed at reducing the burden of care for minors who have undergone craniopharyngioma surgery.

The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery.

Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence. We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI. Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.

Long-Term Outcome of Surgery and Radiation Treatment for Craniopharyngioma

<h3>Purpose/Objective(s)</h3> Treatment of craniopharyngioma, a rare but benign neoplasm, typically entails gross total resection (GTR) or subtotal resection followed by adjuvant radiation (STR-RT). We analyzed progression free survival (PFS) in the adult population undergoing gross total resection versus subtotal resection followed by radiotherapy (RT). <h3>Materials/Methods</h3> A retrospective review was conducted on 67 consecutive patients who were treated for craniopharyngioma. All patients received surgical resection. Patients that had STR also received postoperative radiation treatment. A median dose of 54 Gy (50.4 – 54 Gy) was used with typical dose per fraction of 1.8 Gy five times per week. Three patients were excluded from analysis due to death shortly after surgery (n=1) and no adjuvant RT following STR (n=2) for a total of 64 patients. Regular follow up examinations included contrast MRI scans, physical exams, and clinical evaluation. <h3>Results</h3> Median age was 43 years (19 – 79 years). GTR was achieved in 35 patients and STR-RT in 30 patients. Median tumor size of GTR was 8.64 cm³ (range 1.8 – 40.1 cm³, mean 13.7 cm³) and 19.6 cm³ (range 2.5 – 116.3 cm³, mean 26.2 cm³) for STR-RT (p = 0.03). At a median follow up of 84 months (4 – 255 months) local control rate for all patients treated with GTR or STR-RT was 89.3% at 2 years, 80.1% at 5 years and 73.9% at 10 years. There was one death a week following initial surgery and 2 patients who had STR with no adjuvant RT both had local failure requiring additional intervention at 9 and 26 months. Of 35 patients that had GTR, local control was 91.4% at 2 years, 74.3% at 5 years, and 65.7% at 10 years. Of 12 patients with GTR requiring additional intervention with surgery, RT, or both 100% (n = 12) are stable at last follow up. For the 30 patients with STR-RT local control was 86.7% at 2 years, 86.7% at 5 years and 83.3% at 10 years. 5 patients that underwent STR and adjuvant RT required additional surgical intervention with 100% of patients (n = 5) stable at last follow up. The hazard ratio of STR and RT compared to GTR is 0.49 (CI 0.19 – 1.26), with no significant difference of progression free survival (p = 0.33). <h3>Conclusion</h3> Long term results for patients with craniopharyngioma that underwent subtotal resection followed by radiotherapy demonstrate equivalent local control as compared to gross total resection.

Utility of hospital frailty risk score for predicting postoperative outcomes in craniopharyngioma.

Frailty is an age-associated decline in functional status leading to increased vulnerability to otherwise innocuous stressors. In neurosurgical patients, frailty has been associated with postoperative complications, increased mortality, longer hospitalization, and increased care costs for a variety of conditions. This study seeks to determine the association between frailty and postoperative outcomes in patients undergoing surgery for craniopharyngioma. The Nationwide Inpatient Sample (NIS) database was queried for patients diagnosed with craniopharyngioma who underwent surgery via either craniotomy or transsphenoidal approach. Comorbid diagnoses were used to calculate the Hospital Frailty Risk Score (HFRS) and assign patients to low (< 5), intermediate (5-15), or high-risk (> 15) categories. Logistic regression was completed to determine whether the HFRS category was predictive of mortality, postoperative complication, extended hospitalization, or increased hospital costs compared to age. Increased frailty score was predictive of increased length of stay, increased hospital costs, and non-home discharge in binary logistic regression with good discrimination on the ROC curve compared to age at admission. HFRS risk categories were significantly predictive of the development of any complication, with 100% of high-risk patients developing a complication compared to 76% of intermediate-risk and 63% of low-risk patients. HFRS risk categories were also predictive of the extended length of stay (71%, 49%, and 11% for high-, intermediate-, and low-risk, respectively) and non-home discharge (86%, 56%, and 17%). Regression analysis was unable to be performed for mortality due to the low number of deaths in the study group. In patients undergoing any surgery for craniopharyngioma, frailty is predictive of increased hospital length of stay and overall care costs. HFRS failed to independently predict mortality because the incidence of mortality is too low in this population to analyze. The HFRS is a valuable tool to identify post-operative outcomes following surgery for craniopharyngioma.

Limited surgery and conformal photon radiation therapy for pediatric craniopharyngioma: long-term results from the RT1 protocol.

Our aim was to estimate long-term disease control and complications after conformal radiation therapy (CRT) in children and adolescents with craniopharyngioma. Pediatric patients with craniopharyngioma (n = 101) were enrolled on or treated according to a phase II single institutional protocol from 1998. Surgery was individualized, and CRT (54Gy) was administered using a 1.0 cm or 0.5 cm clinical target volume margin. Patients were followed for 10 years by serial MR imaging and MR angiography and a battery of tests to measure the effects of treatment. Twenty patients had tumor progression. Twelve patients who had tumor progression died due to tumor (n = 6) or complications related to tumor or treatment (n = 6). With a median follow-up of 14.94 years for survivors, the 10 year estimates (±SE) of progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) were 78.84% ± 4.10%, 77.12% ± 4.19%, and 96.02% ± 1.95%, respectively. OS, EFS, and PFS were significantly associated with race, shunt status, and tumor volume. The 10 year cumulative incidence (±SE) of the secondary tumor (1.99% ± 1.40%), secondary malignant tumor (1.0% ± 1.0%), necrosis (1.98% ± 1.39%), vasculopathy (8.47% ± 2.90%), and permanent neurologic deficits (8.28% ± 3.37%) were estimated by competing risk analysis. Three patients required revascularization surgery. Salvage therapy was successful in 13 patients using surgery and radiosurgery. Limited surgery and CRT using photons results in excellent tumor control. Tumor control and the incidence and severity of complications are associated with host, tumor, and treatment factors.

Long-term tumor control after endoscopic endonasal resection of craniopharyngiomas: comparison of gross-total resection versus subtotal resection with radiation therapy.

Surgical management of craniopharyngiomas (CPAs) is challenging. Controversy exists regarding the optimal goals of surgery. The purpose of this study was to compare the long-term outcomes of patients who underwent gross-total resection with the outcomes of those who underwent subtotal resection of their CPA via an endoscopic endonasal approach. From a prospectively maintained database of all endoscopic endonasal approaches performed at Weill Cornell Medicine, only patients with CPAs with > 3 years of follow-up after surgery were included. The primary endpoint was radiographic progression. Data were collected on baseline demographics, imaging, endocrine function, visual function, and extent of resection. A total of 44 patients with a mean follow-up of 5.7 ± 2.6 years were included. Of these patients, 14 (31.8%) had prior surgery. GTR was achieved in 77.3% (34/44) of all patients and 89.5% (34/38) of patients in whom it was the goal of surgery. Preoperative tumor volume < 10 cm3 was highly predictive of GTR (p < 0.001). Radiation therapy was administered within the first 3 months after surgery in 1 (2.9%) of 34 patients with GTR and 7 (70%) of 10 patients with STR (p < 0.001). The 5-year recurrence-free/progression-free survival rate was 75.0% after GTR and 25.0% after STR (45% in subgroup with STR plus radiotherapy; p < 0.001). The time to recurrence after GTR was 30.2 months versus 13 months after STR (5.8 months in subgroup with STR plus radiotherapy; p < 0.001). Patients with GTR had a lower rate of visual deterioration and higher rate of return to work or school compared with those with STR (p = 0.02). Patients with GTR compared to STR had a lower rate of CSF leakage (0.0% vs 30%, p = 0.001) but a higher rate of diabetes insipidus (85.3% vs 50%, p = 0.02). GTR, which is possible to achieve in smaller tumors, resulted in improved tumor control, better visual outcome, and better functional recovery but a higher rate of diabetes insipidus compared with STR, even when the latter was supplemented with postoperative radiation therapy. GTR should be the goal of craniopharyngioma surgery, when achievable with minimal morbidity.