Multimodal treatment of craniopharyngioma: defining a risk-adapted strategy

Craniopharyngiomas remain a therapeutic challenge in terms of treatment-related morbidity. The fact that they are rare, that they are histologically benign, and that anatomically they are located in a challenging area, made them worthy surgical prizes. Whilst surgery has allowed us to meet the challenge of visual salvage, and the advances in hormone replacement therapy are addressing the endocrine challenge, we are becoming increasingly aware that for many children radical resection comes with the cost of devastating effects on quality of life. Increasingly we are recognizing that the next challenge is preservation of hypothalamic function. This consciousness of the morbidity of radical resection has led us, like many pediatric units, to re-examine multimodal treatment strategies. This review examines the Necker experience, aiming to analyze the factors influencing our decision making for treatment.