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Individualized treatment of craniopharyngioma in children: ways and means
J C Marchal1, O Klein, P Thouvenot
1Unit of Paediatric Neurosurgery, Hôpital Central, 27 avenue de Lattre de Tassigny, 54000, Nancy, France. jc.marchal@chu-nancy.fr
Background:
Medium- and long-term prognosis of craniopharyngioma is overwhelmed by the risks of hypothalamic and visual impairment. This problem has been underestimated for a long time because the major concern for the neurosurgeon was the risk of recurrences, their best prevention being thought to be complete tumour resection. Today, we know that radical surgery not only is not an absolute guarantee against recurrences but also can cause hypothalamic and visual complications.
Methods:
The authors suggest that instead of complete removal, the first choice treatment should be, when possible, a less aggressive, multistaged and personalized treatment. In this perspective they focus on other therapeutic methods: endocavity treatment of cysts with rhenium-186, triconformational radiotherapy, radiosurgery, and widespread use of the trans-sphenoidal approach.
Conclusions:
These simple methods should reduce the risks of visual aggravation and metabolic syndrome.
