Microsurgical management of craniopharyngiomas--outcomes in 56 patients

Fifty-six patients with craniopharyngiomas were operated by microsurgical techniques during a 20-year period. Of the 56 patients, 28 were males and 28 were females, with a mean age of 33 years (range 1 to 78 years). Twenty patients (35.7%) were less than 15 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, CT and/or MRI evidence of a decrease in tumor size or tumor disappearance when a patient was discharged from hospital. Ineffectiveness was defined as lack of change in the preoperative clinical status. The mean follow-up period in this study was 6.9 years, with 11 patients monitored. The most common presentation was visual dysfunction (69.6%). 33.9% of the patients presented with headache. The most frequent preoperative finding was a visual field defect, with 55.4% of the patients so affected; 39.5% of patients had preoperative hypothyroidism and 40% had hypoadrenalism. Diabetes insipidus was found preoperatively in 7.1%. Three female patients had amenorrhea. Hydrocephalus was uncommon, being present in only 10.7%. Unruptured aneurysms were found incidentally in 2 cases. A pterional approach was used in 29 patients (52%), a transcallosal approach in 13 (23%), a transcortical approach and a transsphenoidal approaches in 3 (5%), and a lamina terminalis approach in 1 patient. Multiple procedures were required in 8 patients in order to provide significant relief of compressive symptomatology. Overall, 12.5% of the tumors were completely resected. 92.9% of our patients were in remission, 2 had ineffectiveness result, and 2 died of postoperative complications. Except for the completely resected cases, all the other patients underwent radiotherapy postoperatively. The results of this series show that microsurgical management of craniopharyngiomas yields good operative results.