Mohammed A Fouda1,2, R Michael Scott3,4, Karen J Marcus4,5, Nicole Ullrich4,6, Peter E Manley4, Mark W Kieran4, Liliana C Goumnerova3,4. 1. Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. Mohammed.fouda@childrens.harvard.edu. 2. Dana Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Ave, Boston, MA, 02115, USA. Mohammed.fouda@childrens.harvard.edu. 3. Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. 4. Dana Farber/Boston Children's Cancer and Blood Disorders Center, 450 Brookline Ave, Boston, MA, 02115, USA. 5. Division of Radiation Oncology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. 6. Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Abstract
PURPOSE: To demonstrate the paradigm shift in management strategies of pediatric craniopharyngioma at our institution over the past six decades. METHODS: Retrospective analysis of all pediatric patients with craniopharyngioma treated at Boston Children's Hospital between 1960 and 2017. RESULTS: One hundred seventy-eight patients with craniopharyngioma were treated between 1960 and 2017; 135 (70 males and 65 females) fulfilled the inclusion criteria. Forty-five patients were treated in the old era (1960-1984) and 90 patients were treated in the new era (1985-2017). Gross total resection (GTR) was achieved in 4% and 43% of patients in old and new eras respectively. Sub-total resection (STR) and radiotherapy (XRT) were performed in 27% and 28% of patients in old and new eras respectively. STR without XRT was performed in 20% and 29% of patients in old and new era respectively. Cyst drainage and adjuvant radiotherapy were performed in 49% of patients in the old era while no patients in the new era underwent such conservative management. Aggressive surgical resection was associated with a higher risk of worsening visual outcomes (20% vs 16%), panhypopituitarism and diabetes insipidus (86% vs 53%), psycho-social impairment (42% vs 26%), and new-onset obesity (33% vs 22%). The mortality rate was higher in the old era in comparison with that of the new one (9% vs 2%). CONCLUSION: There was a paradigm shift in management strategies of pediatric craniopharyngioma over the past six decades which in turn affected the long-term outcomes and quality of life of patients.
PURPOSE: To demonstrate the paradigm shift in management strategies of pediatric craniopharyngioma at our institution over the past six decades. METHODS: Retrospective analysis of all pediatric patients with craniopharyngioma treated at Boston Children's Hospital between 1960 and 2017. RESULTS: One hundred seventy-eight patients with craniopharyngioma were treated between 1960 and 2017; 135 (70 males and 65 females) fulfilled the inclusion criteria. Forty-five patients were treated in the old era (1960-1984) and 90 patients were treated in the new era (1985-2017). Gross total resection (GTR) was achieved in 4% and 43% of patients in old and new eras respectively. Sub-total resection (STR) and radiotherapy (XRT) were performed in 27% and 28% of patients in old and new eras respectively. STR without XRT was performed in 20% and 29% of patients in old and new era respectively. Cyst drainage and adjuvant radiotherapy were performed in 49% of patients in the old era while no patients in the new era underwent such conservative management. Aggressive surgical resection was associated with a higher risk of worsening visual outcomes (20% vs 16%), panhypopituitarism and diabetes insipidus (86% vs 53%), psycho-social impairment (42% vs 26%), and new-onset obesity (33% vs 22%). The mortality rate was higher in the old era in comparison with that of the new one (9% vs 2%). CONCLUSION: There was a paradigm shift in management strategies of pediatric craniopharyngioma over the past six decades which in turn affected the long-term outcomes and quality of life of patients.
Authors: Aaron J Clark; Tene A Cage; Derick Aranda; Andrew T Parsa; Peter P Sun; Kurtis I Auguste; Nalin Gupta Journal: Childs Nerv Syst Date: 2012-10-23 Impact factor: 1.475
Authors: Mohammed A Fouda; David Zurakowski; R Michael Scott; Karen J Marcus; Peter E Manley; Nicole J Ullrich; Laurie E Cohen; Liliana C Goumnerova Journal: Childs Nerv Syst Date: 2020-09-04 Impact factor: 1.475
Authors: Michael Young; Angela Delaney; Niki Jurbergs; Haitao Pan; Fang Wang; Frederick A Boop; Thomas E Merchant Journal: J Neurooncol Date: 2021-11-30 Impact factor: 4.130
Authors: Mohammed A Fouda; Emily L Day; Steven J Staffa; R Michael Scott; Karen J Marcus; Lissa C Baird Journal: Childs Nerv Syst Date: 2020-10-03 Impact factor: 1.475