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Individualized treatment of pediatric craniopharyngiomas
A Leland Albright1, Costas G Hadjipanayis, L Dade Lunsford
1Department of Neurosurgery, Childrens Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. leland.albright@chp.edu
Insights
Individualized treatment for pediatric craniopharyngiomas is key. This study correlates patient features with outcomes from microsurgical resection, phosphorus-32 irradiation, and gamma knife radiosurgery, finding all are viable options.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Radiation oncology
Background:
- Craniopharyngiomas in children exhibit diverse clinical and radiographic features.
- Individualized treatment strategies are essential for optimal outcomes.
Purpose of the Study:
- To correlate presenting clinical and radiographic characteristics with multimodality treatment outcomes in pediatric craniopharyngiomas.
- To evaluate the safety and efficacy of different treatment modalities.
Main Methods:
- Retrospective review of medical records for pediatric craniopharyngioma patients (1983-2004).
- Analysis of treatments including microsurgical resection, intracavitary irradiation with phosphorus-32 (32P), and gamma knife stereotactic radiosurgery (GKSR).
Main Results:
- No deaths occurred across all treatment groups.
- Microsurgical resection achieved gross total resection in 13/18 patients, with hormonal and visual deficits as primary morbidities.
- Phosphorus-32 (32P) and gamma knife stereotactic radiosurgery (GKSR) showed no operative morbidity or mortality, with GKSR stabilizing or shrinking tumors in 4/5 cases.
Conclusions:
- Microsurgical resection, 32P, and GKSR are complementary treatment modalities for pediatric craniopharyngiomas.
- Each modality has distinct indications and outcomes.
- All treatment options should be available for comprehensive care.
Objective:
The treatment of children with craniopharyngiomas should be individualized because of their heterogeneous clinical and radiographic characteristics. We performed this study to correlate the clinical and radiographic features at the time of presentation with the multimodality treatments the children received.
Methods:
Medical records were reviewed for children with craniopharyngiomas who presented to the Children's Hospital of Pittsburgh for their initial management between 1983 and 2004. Children were treated with microsurgical tumor resections (27), intracavitary irradiation with phosphorus 32 (32P) (12), and with gamma knife stereotactic radiosurgery (GKSR) (5).
Conclusions:
There were no deaths in any treatment group. Gross total resections were thought to be performed in 18 patients and were confirmed by imaging in 13 of the 18 patients. The primary operative morbidities were hormonal and visual. Every child needed at least two replacement hormones and most had panhypopituitarism. Vision worsened postoperatively in 5 of 27 children. There was no operative morbidity or mortality from 32P. After 32P treatment, one child required a later cyst aspiration and one required a craniotomy for progressive cyst enlargement. There was no morbidity or mortality from GKSR, which achieved tumor stabilization or shrinkage in 4 of 5 cases. Resections, 32P, and GKSR are complimentary treatment modalities for children with craniopharyngiomas. Their indications and outcomes differ, but all should be available in the treatment armamentarium.
