The Clinical Behavior and Outcome of Operative Treatment of Craniopharyngiomas: Analysis of 102 Cases

ABSTRACT

The authors reviewed 102 cases of craniopharyngiomas with primary onset, which had occurred during a recent 15-year period. Among the 42 women and 60 men, 34 patients were children(aged 15 or less) and 68 were adults. The children showed clinical characteristics different from those of adults. With regard to initial presentation, headache was the most frequent chief complaint in children, while visual disturbance was most common in adults. The incidence of growth hormone deficiency was high in children, while in adults, adrenal corticosteroid deficit was most common. As seen on CT or MRI, the tumor was larger and calcification was more abundant in children than in adults. Gross total resection(GTR) was achieved in 46 cases. The main causes for incomplete removal were severe adhesion to the hypothalamus(31.3%) and the midbrain(18.8%), and heavy calcification(20.8%). The extent of surgery showed no significant influence on the Karnofsky Performance Score(KPS) on discharge, and in 82.4% of patients the results were good(KPS 80 or more). Postoperative endocrinological disturbances requiring hormonal replacement therapy were more common in the GTR group(p<0.01). In 22 recurrent cases, the median time from initial operation to recurrence was 18.5 months. Among patients who did not undergo postoperative radiation therapy, the recurrence rate was lower in those who had undergone GTR(p<0.05). An analysis of histological characteristics revealed that the adamantinomatous-type tumor recurred more frequently than the squamous papillary type. In conclusion, it is suggested that there is a difference in the growth pattern and clinical behavior of the tumor between adult and childhood craniopharyngioma. The authors recommend that unless expected postsurgical complications are detrimental to the patients, radical total resection should be attempted during the first operation, especially in patients who are under 15 and whose craniopharyngioma is of the adamantinomatous type. Radiation therapy should be considered for patients with a residual tumor and the treatment should be tailored to the individual.