Stereotactic radiosurgery for craniopharyngioma: a systematic review and meta-analysis

Craniopharyngiomas are rare, benign tumors with challenging management due to their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) is an important treatment modality for residual or recurrent cases; however, its efficacy and safety profile require continued assessment. This systematic review and meta-analysis aimed to comprehensively evaluate the outcomes of SRS in craniopharyngioma. A systematic search of Medline, Embase, Scopus, and Web of Science was conducted up to May 2025 in accordance with PRISMA guidelines. Eligible studies included ≥ 3 patients with > 6 months of follow-up, and reporting on SRS outcomes. Key endpoints were pooled using a random-effects model, and meta-regression was performed to identify outcome moderators. Thirty-two studies encompassing 926 patients were included. The pooled overall tumor control rate was 76.1% (95% CI: 68.6-82.3%). Progression-free survival (PFS) was 81.3% (95% CI: 70.8-88.6%) at 3 years and 68.9% (95% CI: 58.5-76.0%) at 5 years. Meta-regression identified cystic tumor composition as a significant predictor of lower PFS, while prior surgery was associated with improved 3-year PFS. Overall survival remained high at 92.7% (95% CI: 88.0-96.1%). Visual improvement occurred in 11.3% of patients (95% CI: 6.3-19.5%). Serious complication rates were low, including visual deterioration (7.4%), hypothalamic dysfunction (0.7%), and new-onset pituitary dysfunction (2.2%). These findings indicate that SRS achieves favorable tumor control and overall survival with a low incidence of major complications in patients with craniopharyngioma. Tumor composition and treatment history significantly influence outcomes, highlighting the importance of individualized patient selection. These findings support the role of SRS as a key modality in the management of residual or recurrent craniopharyngiomas.