Introduction: The goals of surgery in childhood craniopharyngioma have been the subject of much debate. The interhemispheric transcallosal approach has been advocated for difficult cases with third ventricular extension and hypothalamic involvement. This study assesses the efficacy of this approach.
Methods: An IRB-approved, single institution retrospective review was performed on all children operated on for craniopharyngiomas from April 1998 to July 2013. Those patients who had undergone the interhemispheric approach to excise the tumor were identified.
Results: 26 patients were identified, with a median age of 100 months (13-211 months). The median follow up period was 27 months. Twelve patients (46.2%) had gross total resections (GTR) and 14 patients had subtotal resections (STR). Nine patients (34.6%) had tumor recurrence (4 patients with GTR) or progression (5 patients with STR). Seventeen patients had no tumor recurrence (8 patients) or remained stable (9 patients). Seven patients underwent radiation therapy. Seven of the patients who suffered from recurrence had a second surgery; 4 patients underwent a transsphenoidal approach, 2 underwent a pterional approach and 1 underwent a frontotemporal approach. Two of these patients had a third surgery, both undergoing a pterional approach and one of these patients had a fourth surgery, also having a pterional craniotomy.
Eighteen patients (69%) developed new endocrine dysfunction postoperatively. Six of these patients suffered from hypopituitarism, four suffered from diabetes insipidus and two patients suffered from both conditions. Eleven patients developed hypothalamic obesity over the course of their disease. 2 patients (7.7%) developed new visual dysfunction after the operation, which included visual acuity deficits and esotropia.
Conclusions: The interhemispheric transcallosal can be used to treat difficult craniopharyngiomas with third ventricular and hypothalamic involvement. Tumor control rates are acceptable, especially when the approach is combined with radiation therapy.
Patient Care: The research provides an opportunity for patients with difficult craniopharyngiomas to be treated successfully. The study shows that this procedure proved to be effective when paired with radiation.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the post-operative dysfunctions associated with excision of craniopharyngiomas using the interhemispheric approach.
2) Discuss possibilities of enhancing the efficacy of therapeutic treatment.
3) Gain knowledge of an effective procedure to remove difficult craniopharyngiomas.