Craniopharyngioma: surgical experience of 309 cases in China

Abstract

Objective: The objective of the present study was to retrospectively review the surgical outcome of 309 craniopharyngioma cases treated by a single neurosurgeon in China.

Patients and methods: A total of 309 cases of craniopharyngioma that were treated surgically from January 1996 to May 2006. Among them, 162 (52.4%) patients were male and 147 (47.6%) were female. There were 259 (83.8%) patients older than 15 years (mean 35.8 years) and 50 (16.2%) younger than 15 years (mean 8.8 years). The tumor size varied in diameter from 2.0 cm to 9.0 cm (mean 34.5 mm). Pterional approach was performed in 211 (68.3%) cases, trans-laminal terminal approach through frontobasal interhemispheric fissure in 55 (17.8%) cases, subfrontal approach in 20 (6.5%) cases, and transcallosum approach into the anterior third ventricle in 11 (3.6%) cases.

Results: Total, subtotal, and partial removal of tumors were achieved in 276 (89.3%), 20 (6.5%), and 13 (4.2%) patients, respectively. The pituitary stalk was preserved in 186 (60.2%) cases, severed in 49 (15.9%) cases, and unidentified in 74 (23.9%) cases during surgery. There were 12 (3.9%) patients died within 1 month after surgery. A total of 204 (66%) patients were followed from 6 months to 8 years (mean 2.1 years). In the 167 patients with total tumor removal, 23 (13.7%) had tumor recurrence within an average of 1.8 years. While, in the 32 patients with subtotal or partial resection, 24 (75%) had recurrence within an average of 0.5 years. There were five deaths occurred during follow-up.

Conclusion: Pre-surgery neuroimaging evaluations have improved our knowledge of intricate anatomical relationship between craniopharyngioma and the structures of the hypothalamus, pituitary stalk, and optic apparatus, which make total tumor resection feasible with the preservation of these vital structures to ensure a lower recurrence rate with acceptable mortality. However, excessive long-term morbidity, mostly related to hypopituitarism, which leads to the poor quality of life for the craniopharyngioma patients, is still remained. Further effort should be invested to monitor and maintain the normal hormone levels, hence improve the quality of life for craniopharyngioma patients.