Role of radiation therapy and radiosurgery in the management of craniopharyngiomas.

The variable clinical presentation, relation to vital anatomic structures, and complications associated with treatment contribute to the controversies that surround the management of craniopharyngiomas. Although the results with radiation therapy and radiosurgery have been equal to or better than those obtained with aggressive surgery, considerable debate exists regarding the role of surgery alone versus limited surgery followed by radiation therapy. Based on current data, one may consider using surgery for discrete tumors that do not involve the hypothalamus and for which gross total resection would result in minimal cognitive side effects. For tumors that clearly involve the hypothalamus and associated suprasellar structures, subtotal resection followed by radiation therapy tailored for the residual disease seems to offer the best long-term control rates with acceptable morbidity.