Treatment outcomes of pediatric craniopharyngioma : a 15-year retrospective review of 35 cases

Abstract

Objective: The aim of this study was to describe a single center's experience in the management of craniopharyngiomas in children over a 15-year period.

Methods: The clinical records of pediatric patients treated for craniopharyngiomas between December 1995 and February 2011 were reviewed. Thirty-five pediatric patients diagnosed with craniopharyngioma were treated, and their medical records and imaging data were analyzed retrospectively.

Results: The mean follow-up duration was 76 months (range, 10-195). Overall survival and local control rates at 10 years were 94.7±5.1% and 37.1±11.9%, respectively. The female-to-male ratio was 16 : 19, and the mean age was 8.6 years (range, 1-17). Initially, gross total resection (GTR) was performed in 30 patients; subtotal resection (STR) followed by radiotherapy was performed in 5 patients. Of the 14 cases that showed recurrence after GTR, 5 patients were treated with GTR, 1 with radiation therapy (RT), 4 with gamma knife radiosurgery (GKRS), and 4 with subtotal resection followed by RT. No patients who underwent RT or GKRS had recurrences. Two cases with recurrence after STR followed by RT were treated with GTR. One patient died of hormonal insufficiency 64 months after the first surgery. The overall median time progression was 51.2 months (range, 3-182) : 49.7 months in the patients who underwent GTR and 60.2 months in the patients who underwent STR followed by RT.

Conclusion: If safe resection is possible, GTR at the initial treatment should be attempted to reduce the tumor recurrence. However, if the tumor recurs after the first surgery, RT or GKRS with/without reoperation may be an effective salvage treatment for recurrent craniopharyngioma.

Keywords: Craniopharyngioma; Microsurgery; Radiotherapy.

Fig. 1

Graph showing overall survival and local control rates in 35 patients with craniopharyngiomas over the follow-up period. Overall survival and local control rates at 10 years are 94.7±5.1% and 37.1±11.9%, respectively.

Fig. 2

Graph showing local tumor control rates in 14 patients with recurrence after initial treatment (GTR) stratified by radiation therapy (RT) or radiosurgery received (GKRS) (p=0.00). Five patients are treated with repeat surgery (GTR), 9 patients with RT or GKRS. GTR : gross total resection, GKRS : gamma knife radiosurgery, RT : radiation therapy, STR : subtotal resection.