J Korean Neurosurg Soc.  2015 Nov;58(5):432-441. 10.3340/jkns.2015.58.5.432.

Is the Complete Resection of Craniopharyngiomas in Adults Feasible Considering Both the Oncologic and Functional Outcomes?

• Lee EJ
• Cho YH
• Hong SH
• Kim JH
• Kim CJ

• KMID: 2191408
• DOI: http://doi.org/10.3340/jkns.2015.58.5.432

Abstract

OBJECTIVE
To assess the impact of the complete resection of craniopharyngioma (CP) in adults on oncologic and functional outcomes.
METHODS
We retrospectively analyzed 82 patients with CP who were surgically treated by the same neurosurgeon at our institution between January 1994 and December 2012.
RESULTS
Gross total resection (GTR) was achieved in 71 patients (86.6%), near total resection (NTR) in 7 patients (8.5%), and subtotal resection (STR) in 3 patients (3.7%). The disease-specific overall survival rate was 100% with the exclusion of 2 surgery-related mortalities. The overall recurrence rate was 12.2% (10 of 82 patients), however the recurrence rate according to extent of resection (EOR) was 9.9% (7 of 71 patients) after GTR, 14.3% (1 of 7 patients) after NTR, and 66.7% (2 of 3 patients) after STR. The overall recurrence-free survival (RFS) rates at 5 and 10 years were 87.0% and 76.8%, respectively. Postoperatively, most patients (86.3%) needed hormone replacement for at least 1 hypothalamic-pituitary axis. Vision improved in 56.4% of the patients with preoperative abnormal vision, but deteriorated in 27.4% of patients. Hypothalamic dysfunction developed in 32.9% of patients. There were no significant differences in the risks of pituitary dysfunction, visual deterioration, or hypothalamic dysfunction between the groups with complete vs. incomplete removal. The overall rate of postoperative complications was 22.0%, which did not differ between groups (p=0.053).
CONCLUSION
The complete removal of a CP at first surgery can provide a chance for a cure with acceptable morbidity and mortality risks.

Keyword

Craniopharyngioma; Microsurgery; Residual tumor; Recurrence; Morbidity

MeSH Terms

Adult*
Axis, Cervical Vertebra
Craniopharyngioma*
Humans
Microsurgery
Mortality
Neoplasm, Residual
Postoperative Complications
Recurrence
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Preoperative magnetic resonance images of a 21-year-old male patient with seizure showing a sellar and suprasellar mass composed of solid and huge cystic portions extending into the right frontal lobe, which is compatible with craniopharyngioma.

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  Fig. 2 Magnetic resonance images of a 15-year-old female patient with headache showing a large complex cystic mass at the prepontine cistern with extension into the suprasellar area. She underwent a staged operation via the lateral suboccipital approach and lateral subfrontal approach in order to achieve gross total resection.

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  Fig. 3 Kaplan-Meier recurrence-free survival curve of patients who underwent surgery for craniopharyngioma.

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  Fig. 4 Kaplan-Meier curves comparing recurrence-free survival between the gross total resection (GTR) and non-GTR groups.

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  Fig. 5 Kaplan-Meier recurrence-free survival curves of the patients who followed up more than 1 year. A : Graph shows the overall recurrence-free survival rates. B : Graph compares recurrence-free survival between the GTR and non-GTR groups. For patients with follow-up ≥12 months (n=73). GTR : gross total resection.

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