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  • Outcome of Radical Surgery in Adult Craniopharyngiomas

    Final Number:
    1035

    Authors:
    Raul Lopez Serna MD; Lesly Portocarrero-Ortiz MD, M.Sc.; Rogelio Revuelta-Gutierrez MD; Juan Barges Coll; Miguel Celis-Lopez MD; Ulises Garcia-Gonzalez; Juan Luis Gomez Amador MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Craniopharyngiomas (CPs) are rare and mostly benign epitelial disembryogenic tumors that mostly present in children (1,3,4,5). A less numerous adult group can be found by the fifth to seventh decades of life (10). There are two recognized histological variants of CPs, the adamantinomatous type is more prevalent in children while the papillary type is almost exclusively found in adults (2,3). Based on the reduced number of published series dealing with this pathology in adults, studies in this age group gain importance based on two main facts, the low number of cases and the possible differences emerging from a mostly different histological type.

    Methods: Retrospective review of 153 patients treated surgically in our center between January 1985 and December 2009.

    Results: Transcranial approaches were used in 84% of the cases. Gross Total Removal (GTR) was achieved 30.46% of patients, Near Total (NTR) in 21.85%, Subtotal (STR) in 15.23% and Partial (PR) in 19 (12.58%). Follow-up time ranged from 4 to 164 months (mean, 56 months). Tumor relapse was significantly less frequent after GTR (5 of 46, 10.86%) than after NTR or STR with or without radiotherapy (RT) (23 of 56, 41.07%) (P < 0.01). Overall rate of surgical complications was 15.6%. The overall rate of new endocrinopathies for all patients undergoing surgery was 37.25% (95% CI = 33.9–41.2). Hormonal postoperative defficiencies of TSH and ACTH were both the most clinically significant and the most frequently found (67% and 70.5%, respectively).Figure 1.

    Conclusions: After reviewing our unacceptable high number of endocrine complications resulting from radical surgical strategies we concluded subtotal resection with adjuvant radiotherapy could serve as a desirable replacement for GTR when tumor remnants are located on critical structures or disease progression is documented after surgery.

    Patient Care: After reviewing our unacceptable high number of endocrine complications resulting from radical surgical strategies we concluded subtotal resection with adjuvant radiotherapy could serve as a desirable replacement for GTR when tumor remnants are located on critical structures or disease progression is documented after surgery.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the prevalence and special nuances of CPs in adults, 2) Discuss, in small groups which would be the best therapeutic strategy in these patients 3) Identify an effective treatment after reviewing the complications emerging from radical surgeries.

    References: 1. Al-Mefty O, Hassounah M, Weaver P, Sakati N, Jinkins JR, Fox JL: Microsurgery for giant craniopharyngiomas in children. Neurosurgery. 17, 585–595 (1985). 2. Banna M: Craniopharyngioma in adults. Surg Neurol. 1, 202–204 (1973). 3. Banna M, Hoare RD, Stanley P, Till K: Craniopharyngioma in children. J Pediatr. 83, 781–785 (1973). 4. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM: The descriptive epidemiology of craniopharyngioma. J Neurosurg. 89, 547–551 (1998). 5. Carmel PW, Antunes JL, Chang CH: Craniopharyngiomas in children. Neurosurgery. 11, 382–389 (1982). 6. DeVile CJ, Grant DB, Hayward RD, Stanhope R: Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child. 75, 108–114 (1996). 7. Finken MJ, Zwaveling-Soonawala N, Walenkamp MJ, Vulsma T, van Trotsenburg AS, Rotteveel J: Frequent occurrence of the triphasic response (diabetes insipidus/hyponatremia/diabetes insipidus) after surgery for craniopharyngioma in childhood. Horm Res Paediatr. 76(1), 22-26 (2011). 8. Ghirardello S, Hopper N, Albanese A, Maghnie M: Diabetes insipidus in craniopharyngioma: postoperative management of water and electrolyte disorders. J Pediatr Endocrinol Metab. 19 Suppl 1, 413-421 (2006). 9. Gonc EC, Yordam N, Ozon A, Alikasifoglu A, Kandemir N: Endocrinological outcome of different treatment options in children with craniopharyngioma: A retrospective analysis of 66 cases. Pediatr Neurosurg. 40(3), 112-119 (2004). 10. Haupt R, Magnani C, Pavanello M, Caruso S, Dama E, Garrè ML: Epidemiological aspects of craniopharyngioma. J Pediat Endocrinol. 1, 289–293 (2006).

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