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Craniopharyngiomas in children - experience of consecutive 152 operated cases
A V Ciurea1, V Saceleanu2,3, A Mohan4,5
1"Carol Davila" University School of Medicine - Department of Neurosurgery.
Insights
Surgery is the primary treatment for pediatric craniopharyngioma (CPH). A multidisciplinary approach is crucial due to potential complications, with age and tumor characteristics influencing outcomes.
Area of Science:
- Pediatric neurosurgery
- Oncology
- Quality of life studies
Background:
- Craniopharyngiomas (CPH) are rare pediatric intracranial tumors.
- This multicenter study analyzed surgical management and quality of life in 152 children over 25 years.
Observation:
- The pterional approach is recommended for CPH.
- Gross-total removal (GTR) was achieved in 54.4% of cases.
- Postoperative complications included diabetes insipidus (89.3%) and hypopituitarism (66.4%).
Findings:
- Good Recovery (46.2%) and Moderate Disability (40.7%) were observed at 6 months post-surgery.
- Surgery remains the main treatment option for pediatric CPH.
- Age, tumor size, hydrocephalus, and hypothalamic dysfunction predict outcomes.
Implications:
- A multidisciplinary approach is essential for managing CPH complications.
- Optimizing surgical strategies can improve long-term quality of life for pediatric CPH patients.
Context:
Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors.
Objective:
This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases.
Design:
This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest.
Subjects And Methods:
152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease.
Results:
Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%).
Conclusions:
Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.
