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Craniopharyngiomas of childhood: the CHLA experience
Ivan J Sosa1, Mark D Krieger, J Gordon McComb
1Division of Neurological Surgery, Department of Neurological Surgery, Keck School of Medicine, Childrens Hospital of Los Angeles, University of Southern California, 1300 N. Vermont Avenue, Suite 1006, Los Angeles, CA 90027, USA.
Insights
This study analyzed craniopharyngioma treatment in children, finding that complete tumor removal with surgery alone achieved good outcomes. Careful surgical planning is crucial for maximizing gross total resection and minimizing neurological deficits.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Cranial base surgery
Background:
- Craniopharyngiomas are rare pediatric tumors.
- Treatment strategies aim to maximize tumor removal while preserving neurological function.
Purpose of the Study:
- To analyze treatment outcomes for pediatric craniopharyngiomas.
- To identify factors influencing treatment success and complications.
Main Methods:
- Retrospective review of pediatric craniopharyngioma cases treated at Childrens Hospital of Los Angeles (CHLA) from 1993 to 2004.
- Analysis of surgical techniques, adjuvant therapies, and patient outcomes.
Main Results:
- Tumor control was achieved in 34 of 35 patients.
- Complete tumor resection was obtained in 25 patients, primarily through surgery.
- Radiation therapy was used for recurrent tumors.
Conclusions:
- Preoperative planning is essential to maximize gross total tumor removal.
- Intraoperative decision-making regarding extent of resection is critical to avoid irreversible neurological deficits.
- Staged removal and consideration of different operative corridors may be beneficial.
Objective:
To improve the outcome of children with craniopharyngiomas by analyzing how they were treated.
Methods:
The records of patients who underwent operation at Childrens Hospital of Los Angeles (CHLA) from 1993 to 2004 were reviewed.
Results:
Identified were 19 girls and 16 boys with an age range from 9 days to 16 years (mean 7 years, mode 3 years). Tumor control was achieved in 34 of 35 patients and was accomplished with reasonable outcome in terms of neurological deficits and overall level of function. In 25 patients, complete tumor resection was obtained with surgery alone, 18 with the first resection, and 7 with repeat operative intervention. Nine children received radiation therapy after the first or second recurrence. On retrospective review, there were no consistently identifiable features that would lead one to determine preoperatively which tumors would fall into a given category.
Conclusion:
We believe that the surgeon must determine a preoperative plan that maximizes the chance for a gross total removal of the craniopharyngioma. The biggest challenge intraoperatively is to determine whether to continue with the attempt at gross total removal or stop short of that goal before producing a significant irreversible neurological deficit. A staged removal using different operative corridors also needs to be considered.
