The role of stereotactic techniques in the management of craniopharyngiomas

Despite the advances of microsurgery, endocrinology, radiation therapy, and neuroimaging over the last half-century, craniopharyngiomas continue to present neurosurgeons with a therapeutic dilemma. The tumor's histologic benignity belies its aggressive biologic behavior. Although total resection is theoretically curative, the cost in terms of functional disability can be high, especially in light of reports describing long-delayed tumor recurrences ("false cure"). As in other intracranial neoplasms, multimodality therapy is often necessary over the course of a patient's lifetime. Stereotactic techniques (intracystic irradiation, radiosurgery, cyst aspiration, biopsy) have a well-established role in selected cases. To maximize preservation of neurologic, visual, and hypothalamic-pituitary functions, the application of stereotactic, microsurgical, or external irradiation techniques in an individual patient must take into account all of the patient's prior treatments as well as the current status of his or her tumor. Our current recommendation for multimodality treatment of craniopharyngiomas is illustrated in Figure 5. Stereotactic surgery has a definitive role in the life-long management of some patients, and plays an important adjunctive role in many others.