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Radical excision of pediatric craniopharyngioma: recurrence pattern and prognostic factors
1Division of Pediatric Neurosurgery, Cancer Research Institute, Seoul National University Children's Hospital, Korea.
Insights
Pediatric craniopharyngiomas with intrasellar components recur more often after surgery. Regular neuroimaging follow-up is crucial for early detection of recurrence in these children.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Tumor Biology
Background:
- Craniopharyngiomas are rare pediatric brain tumors.
- Radical excision is a primary treatment, but recurrence is a concern.
- Understanding recurrence patterns and prognostic factors is vital for patient management.
Purpose of the Study:
- To investigate recurrence patterns in pediatric craniopharyngiomas post-radical excision.
- To identify prognostic factors influencing tumor recurrence.
- To evaluate the effectiveness of regular neuroimaging follow-up.
Main Methods:
- Retrospective review of 36 pediatric craniopharyngioma patients.
- All patients underwent radical excision without radiotherapy.
- Mean follow-up of 52 months, analyzing recurrence rates, sites, and survival.
Main Results:
- Tumors recurred in 14 patients (38.9%), with a 5-year recurrence-free survival of 55%.
- Intrasellar tumor component was the sole significant predictor of recurrence (39% vs 81% 5-year RFS).
- Regular neuroimaging detected recurrences early; recurrent tumors showed higher Ki-67 labeling indices.
Conclusions:
- Craniopharyngiomas with intrasellar components require cautious follow-up due to higher recurrence risk.
- Emphasize regular neuroimaging surveillance, even after apparent total resection.
- Ki-67 labeling index of primary tumors lacks prognostic value, but increases in recurrence.
Abstract:
The purpose of our study was to investigate the pattern of recurrence and the prognostic factors for recurrence of pediatric craniopharyngiomas after radical excision. A series of 36 patients with craniopharyngiomas (21 boys and 15 girls; age range 1-15 years; mean 7.3 years) were reviewed. All patients had undergone radical excision without radiotherapy. The mean follow-up period was 52 months (range 1-149 months). Tumors recurred in 14 patients within 83 months (mean 31.4 months). The overall 5-year recurrence-free survival rate was 55%. Regular neuroimaging follow-up detected tumor recurrence while the lesions were still small before symptoms developed (P<0.05). At the first surgical procedure, the optic nerve/chiasm (n=23) was the most common adhesion site. The most frequent sites of recurrence were the optic nerve/chiasm (n=6) and the pituitary fossa (n=6). Tumor location was the single significant clinical predictor of recurrence. The 5-year recurrence-free survival rate was 39% for those who had an intrasellar tumor component and 81% for those who did not (P<0.05). The Ki-67 labeling indices (LIs) of primary tumors did not have prognostic value for recurrence. Recurrent tumors tended to have higher Ki-67 LIs than their primary counterparts. On the basis of this study, we concluded that craniopharyngiomas with intrasellar components should be followed cautiously and the necessity for regular follow-up should be emphasized, even when the tumor is "totally" resected.