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Pediatric craniopharyngioma--rationale for multimodal management: the Egyptian experience
Mohamed A Hafez1, Sherif ElMekkawy, Hazem AbdelBadie
1Department of Neurosurgery, Cairo University Hospitals, Cairo, Egypt. dindinosi@hotmail.com
Insights
Complete surgical removal of craniopharyngioma offers the best outcomes, though it carries higher initial risks. Radiotherapy is crucial for long-term tumor control, especially after subtotal removal.
Area of Science:
- Pediatric Neurosurgery
- Oncology
- Endocrinology
Background:
- Craniopharyngiomas are suprasellar tumors causing significant endocrinological, visual, and neurological deficits.
- Management requires a multidisciplinary 'craniopharyngioma team'.
Purpose of the Study:
- To assess surgical extent and radiotherapy impact on craniopharyngioma outcomes.
- Evaluate direct postoperative and long-term results.
Main Methods:
- Retrospective analysis of 62 pediatric craniopharyngioma cases.
- Cases stratified by surgical removal extent: complete (A), subtotal (B), partial (C).
- Groups Ar and Br received primary postoperative radiotherapy.
Main Results:
- Complete removal (A) showed significantly lower recurrence than subtotal (B) but higher morbidity/mortality.
- Partial removal (C) yielded the poorest results.
- Radiotherapy provided long-term control for recurrent tumors and in groups Ar and Br.
Conclusions:
- Total surgical removal is the primary goal for craniopharyngioma.
- Subtotal removal is acceptable for aggressive tumors; partial removal should be avoided.
- Adjuvant radiotherapy is effective for long-term tumor control.
Background:
Situated in a suprasellar location, craniopharyngiomas produce devastating endocrinological manifestations, visual impairment, and raised intracranial pressure, presenting a formidable disease entity for the neurosurgeon as well as the 'craniopharyngioma team'.
Objective:
To evaluate direct postoperative and long-term results based on the extent of surgical removal and administration of radiotherapy.
Patients And Methods:
Sixty-two new cases of pediatric craniopharyngioma were divided into three groups according to extent of removal: A (complete), B (subtotal), and C (partial). Groups A and B receiving primary postoperative radiotherapy were tagged groups Ar and Br.
Results:
Group A had significantly less recurrence rate than group B (p < 0.005); however, direct postoperative morbidity and mortality were worse (p < 0.05). Group C fared worse than the other two groups. In groups A and B with recurrence and in groups Ar and Br, radiotherapy provided long-term control.
Conclusion:
The aim at first surgery should be total removal. Subtotal removal is warranted for more resilient tumors, while partial removal should be avoided as it provides poor results. Adjuvant radiotherapy is a useful tool in providing long-term tumor control.
