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Craniopharyngiomas: our experience in Lyon.
C Mottolese1, A Szathmari, P Berlier
1Pediatric Neurosurgical Service, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, 59 Boulevard Pinel, Lyon Cedex 3, France. carmine.mottolese@chu-lyon.fr
Summary
Intracystic chemotherapy with bleomycin offers better outcomes for pediatric craniopharyngiomas, showing reduced morbidity and mortality compared to surgery alone. This approach is recommended for cystic tumors, with surgery reserved for solid or resistant cases.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Endocrinology
Background:
- Craniopharyngiomas in children present unique surgical challenges.
- Surgical outcomes are debated, with ongoing efforts to improve success rates and reduce complications.
- Quality of life is significantly impacted by the tumor's proximity to critical structures like the hypothalamus, optic pathways, and vascular supply.
Purpose of the Study:
- To review the institution's experience with surgical and chemotherapeutic treatment of pediatric craniopharyngiomas.
- To compare the efficacy and safety of direct surgical intervention versus intracystic bleomycin chemotherapy.
- To identify optimal treatment strategies for different craniopharyngioma subtypes.
Main Methods:
- Retrospective review of 60 pediatric patients treated between 1985 and 2004.
- Patients were divided into two groups: direct surgery (36 patients) and intracystic bleomycin chemotherapy (24 patients, some with prior surgery).
- Pre- and postoperative MRI were utilized for assessment since 1987.
Main Results:
- Total lesion removal in surgery group: 74%. Early and late mortality in surgery group: 5% and 11% respectively.
- Intracystic bleomycin group showed cyst disappearance (12/18) or significant reduction/stabilization (6/18) with no mortality.
- Endocrine and visual deficits were lower in the bleomycin group; 14/16 school-aged children maintained normal educational programs.
Conclusions:
- Intracystic bleomycin chemotherapy alone demonstrated superior outcomes with significantly lower morbidity and mortality for pediatric craniopharyngiomas.
- Bleomycin is the preferred treatment for cystic craniopharyngiomas.
- Surgery remains an option for solid tumors or those unresponsive to intracystic chemotherapy.