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Sixty years single institutional experience with pediatric craniopharyngioma: between the past and the future
Mohammed A Fouda1,2, R Michael Scott3,4, Karen J Marcus4,5
1Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. Mohammed.fouda@childrens.harvard.edu.
Insights
Pediatric craniopharyngioma management shifted towards aggressive surgery, improving survival but increasing risks of hormonal and visual deficits. This study analyzes six decades of treatment evolution and patient outcomes.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Clinical outcomes research
Background:
- Craniopharyngioma is a rare pediatric brain tumor with significant long-term morbidity.
- Management strategies have evolved over decades, impacting patient outcomes.
Purpose of the Study:
- To analyze the paradigm shift in pediatric craniopharyngioma management over six decades.
- To evaluate the impact of changing treatment strategies on patient outcomes and quality of life.
Main Methods:
- Retrospective analysis of 135 pediatric craniopharyngioma patients treated between 1960 and 2017.
- Comparison of treatment approaches and outcomes between an 'old era' (1960-1984) and a 'new era' (1985-2017).
Main Results:
- Gross total resection rates increased from 4% to 43% from the old to the new era.
- Aggressive surgery correlated with higher rates of panhypopituitarism (86% vs 53%) and visual decline (20% vs 16%).
- Mortality decreased significantly from 9% in the old era to 2% in the new era.
Conclusions:
- A significant paradigm shift in pediatric craniopharyngioma management has occurred.
- While survival has improved, aggressive surgical approaches have led to increased long-term morbidities, affecting quality of life.
Purpose:
To demonstrate the paradigm shift in management strategies of pediatric craniopharyngioma at our institution over the past six decades.
Methods:
Retrospective analysis of all pediatric patients with craniopharyngioma treated at Boston Children's Hospital between 1960 and 2017.
Results:
One hundred seventy-eight patients with craniopharyngioma were treated between 1960 and 2017; 135 (70 males and 65 females) fulfilled the inclusion criteria. Forty-five patients were treated in the old era (1960-1984) and 90 patients were treated in the new era (1985-2017). Gross total resection (GTR) was achieved in 4% and 43% of patients in old and new eras respectively. Sub-total resection (STR) and radiotherapy (XRT) were performed in 27% and 28% of patients in old and new eras respectively. STR without XRT was performed in 20% and 29% of patients in old and new era respectively. Cyst drainage and adjuvant radiotherapy were performed in 49% of patients in the old era while no patients in the new era underwent such conservative management. Aggressive surgical resection was associated with a higher risk of worsening visual outcomes (20% vs 16%), panhypopituitarism and diabetes insipidus (86% vs 53%), psycho-social impairment (42% vs 26%), and new-onset obesity (33% vs 22%). The mortality rate was higher in the old era in comparison with that of the new one (9% vs 2%).
Conclusion:
There was a paradigm shift in management strategies of pediatric craniopharyngioma over the past six decades which in turn affected the long-term outcomes and quality of life of patients.
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