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Surgical treatment of craniopharyngiomas in children
Insights
Surgical outcomes for pediatric craniopharyngiomas are challenging. Radical tumor removal in children is difficult, with significant risks and a high failure rate, necessitating careful surgical planning.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Surgical Oncology
Background:
- Craniopharyngiomas are rare pediatric brain tumors.
- Surgical management presents significant challenges in young patients.
Purpose of the Study:
- To detail surgical difficulties encountered in pediatric craniopharyngioma cases.
- To report treatment outcomes for 50 children with craniopharyngiomas.
Main Methods:
- Retrospective analysis of 50 pediatric craniopharyngioma cases.
- Surgical procedures focused on radical capsule removal.
- Unilateral tumor excision attempted, with staged contralateral surgery if needed.
Main Results:
- 10 patients presented in a sub-comatose state; 4 experienced respiratory arrest.
- Radical excision attempted in 20, completed in 13; 3 deaths occurred.
- Capsule separation from the hypothalamus interrupted in 7 cases; overall failure rate in one-third of cases.
Conclusions:
- Surgical treatment of pediatric craniopharyngiomas is complex and carries substantial risks.
- Radical excision is challenging, with a notable failure rate and potential for hypothalamic injury.
- Careful surgical strategy, including staged contralateral operations, is crucial for managing these tumors.
Abstract:
This paper sets out the surgical difficulties and the results of treatment in 50 cases of craniopharyngiomas in children up to the age of 13. During surgery, 10 patients were in a sub-comatose state, while 4 had respiratory arrest. Two-thirds of the children under 10 were given an A-V shunt implant. Radical excisions were attempted in 20 cases but were executed in only 13. Three of these died. Separation of the upper and posterior part of the capsule from the hypothalamus had to be interrupted in seven cases. The object of the operation was the radical removal of the capsule. We failed in one-third of our cases. Tumour excision is always attempted unilaterally. When this proves impossible, a second operation is undertaken on the opposite side when the hypothalamic disturbance subsides. If repeated surgery is indicated, it is always performed on the opposite side of the primary operation.