An approach to radical excision of craniopharyngioma by the temporal route.

Attempts at radical excision of craniopharyngioma has been made increasingly possible by the advent of neuroradiological imaging and the use of microscopic technique. Between 1977 and 1993, 62 patients of The National Hospital for Neurology and Neurosurgery, London, have undergone surgical excision of craniopharyngioma by the temporal route, with a small anterior temporal resection. Surgical mortality was 4%. Forty-eight patients (76%) remain well on average follow-up of 34 months. Twelve percent had major complications (hypothalamic damage, subdural haematoma, scalp collections requiring shunt drainage). There were four recurrences in patients where the initial operations were considered as complete microscopic excision. Maximal control of tumour recurrence by removal of all tumour accessible and visible to the surgical microscope is best achieved by radical excision at the first operation.