OBJECT: Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric craniopharyngioma. METHODS: The authors performed a systematic review of the published literature on pediatric craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. RESULTS: Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal resection (STR) was not associated with an increased rate of new neurological deficits. Gross-total was associated with increased rates of diabetes insipidus (OR 7.7, p = 0.05) compared with the combination of STR and radiotherapy (RT). The addition of RT to STR was associated with increased rates of panhypopituitarism (OR 9.9, p = 0.01) but otherwise similar rates of morbidities. CONCLUSIONS: Although subject to the limitations of a literature review, this report suggests that GTR is associated with increased rates of endocrinopathies compared with STR + RT, and this should be considered when planning goals of surgery.
OBJECT: Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric craniopharyngioma. METHODS: The authors performed a systematic review of the published literature on pediatric craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. RESULTS: Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal resection (STR) was not associated with an increased rate of new neurological deficits. Gross-total was associated with increased rates of diabetes insipidus (OR 7.7, p = 0.05) compared with the combination of STR and radiotherapy (RT). The addition of RT to STR was associated with increased rates of panhypopituitarism (OR 9.9, p = 0.01) but otherwise similar rates of morbidities. CONCLUSIONS: Although subject to the limitations of a literature review, this report suggests that GTR is associated with increased rates of endocrinopathies compared with STR + RT, and this should be considered when planning goals of surgery.
Authors: Annett Hölsken; Christina Stache; Sven Martin Schlaffer; Jörg Flitsch; Rudolf Fahlbusch; Michael Buchfelder; Rolf Buslei Journal: Pituitary Date: 2014-12 Impact factor: 4.107
Authors: Shannon Coy; Rumana Rashid; Jia-Ren Lin; Ziming Du; Andrew M Donson; Todd C Hankinson; Nicholas K Foreman; Peter E Manley; Mark W Kieran; David A Reardon; Peter K Sorger; Sandro Santagata Journal: Neuro Oncol Date: 2018-07-05 Impact factor: 12.300
Authors: Todd C Hankinson; Nicholas O Palmeri; Sarah A Williams; Michelle R Torok; Cesar A Serrano; Nicholas K Foreman; Michael H Handler; Arthur K Liu Journal: Pediatr Neurosurg Date: 2014-02-21 Impact factor: 1.162
Authors: Andrew J Bishop; Brad Greenfield; Anita Mahajan; Arnold C Paulino; M Fatih Okcu; Pamela K Allen; Murali Chintagumpala; Lisa S Kahalley; Mary F McAleer; Susan L McGovern; William E Whitehead; David R Grosshans Journal: Int J Radiat Oncol Biol Phys Date: 2014-07-19 Impact factor: 7.038