[Radical or conservative surgery in craniopharyngioma? Importance of individualized treatment!]

In a retrospective study of 36 children aged 3-16 years, undergoing 'radical' surgery for craniopharyngioma, postoperative radiography showed tumour excision to have been complete in 25 cases and partial in 11 cases. The recurrence rate was 40% among those treated with surgery alone (N = 27), whereas there were no recurrences among those given adjunctive radiotherapy (RT) (N = 9). Although surgery in the hypothalamic region carries a high risk of severe lasting sequelae, long-term follow-up (mean duration 15 years) showed no difference in this respect between the RT and non-RT subgroups. Until large, preferably international, prospective studies may resolve the lack of consensus regarding the optimal treatment of craniopharyngioma, the authors advocate a more individualised approach, the choice between different treatment modalities and combinations being based on tumour size, location and structure.