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Craniopharyngiomas in children: recurrence, reoperation and outcome
Matthieu Vinchon1, Patrick Dhellemmes
1Service de Neurochirurgie Pédiatrique, CHRU de Lille, 59 037, Lille Cedex, France. m-vinchon@chru-lille.fr
Insights
Reoperation for recurrent craniopharyngioma in children offers effective tumor control. This approach is recommended for solid recurrent tumors, with morbidity linked to tumor aggressiveness rather than surgery.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Tumor recurrence management
Background:
- Craniopharyngioma recurrence is common and associated with high morbidity in children.
- Long-term outcomes following recurrence and reoperation for craniopharyngioma are not well-documented.
Purpose of the Study:
- To evaluate the efficacy and outcomes of reoperation for pediatric recurrent craniopharyngioma.
- To analyze factors influencing morbidity and survival after reoperation for recurrent craniopharyngioma.
Main Methods:
- Retrospective analysis of 20 children with recurrent craniopharyngioma undergoing reoperation between 1981 and 2007.
- Surgical resection for solid recurrences; stereotactic techniques for cystic recurrences; external irradiation for unresectable tumors.
Main Results:
- 29 reoperations were performed; total resection achieved in 12 cases.
- Event-free survival was 49.9% at 5 years and 40.0% at 10 years.
- At mean follow-up of 70.4 months, 9 patients were tumor-free and 10 had stable disease.
Conclusions:
- Reoperation is an effective strategy for controlling recurrent craniopharyngioma, particularly for solid tumors.
- Morbidity is primarily associated with tumor aggressiveness, not surgical intervention.
- Reoperation should be considered for recurrent craniopharyngioma when feasible.
Introduction:
Craniopharyngioma bears a high rate of recurrence and morbidity in childhood. Although the outcome after recurrence and reoperation is an important parameter for the long-term evaluation of craniopharyngioma, it is poorly documented in literature.
Materials And Methods:
We studied children reoperated for recurrent craniopharyngioma in our institution since the advent of computed tomography (CT) scanner. Reoperation for tumor resection was decided whenever the recurrence was solid, with the aim total resection if possible and reasonable. Stereotactic techniques were used in case of cystic recurrence, and external irradiation was used only in case of recurrent tumor not amenable to surgery.
Results:
From September 1981 to January 2007, we performed one or more reoperations in 20 children presenting with recurrent craniopharyngiomas. The total number of reoperations was 29: resection was total in 12 cases, near-total in 8 cases, partial in 8 cases, and undocumented in 1. In addition, stereotactic procedures were performed in 11 cases, and 5 patients underwent external irradiation.
Discussion:
No patient died after surgery or because of tumor progression; one patient died abruptly of an undiagnosed cause during external irradiation. The event-free survival after reoperation was 49.9% at 5 years and 40.0% at 10 years. At last control, after a mean follow-up of 70.4 months after the last surgery, nine patients were tumor-free and ten had stable disease.
Conclusion:
Reoperation for recurrent craniopharyngioma is an efficient method for tumor control and should be proposed whenever the recurrent tumor is solid. Morbidity results above all from tumor aggressiveness, rather than from surgical damage.
