retrospective analysis of the treatment results of 24 cases of pediatric craniopharyngioma. A single institution experience

ABSTRACT

This is a retrospective study of all cases of pediatric Craniopharyngioma who attended from January 1992 till January 2002 to the Pediatric Unit of Kasr El-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK]. All cases were diagnosed by brain CT scan or Magnetic resonance imaging [MRI] and diagnosis was confirmed by pathological examination. Eight cases underwent total surgical excision and 16 cases underwent near total excision of the tumor and postoperative radiation therapy. All cases were followed up clinically every 3 months by assessment of neurological function. Brain MRI and endocrinal functions were assessed every 6 months for 5 years. The overall survival at 5 years was 90%. The 5 year progression free survival [PFS] was 62.5%, 5 cases developed surgery related complications and 4 cases developed radiation related complications as visual deterioration, pan-hypopituitrism and disturbed cognitive and neuropsychological disorders. The two standard treatment options in children with craniopharyngioma are primary total surgical excision of the tumor or subtotal resection followed by radiotherapy. In certain subgroups of patients such as those with large tumors and hypothalamic extension, primary surgery is associated with a high incidence of complications and high failure rates. We recommend the utilization of an individualized risk adapted treatment approach which attempts to maximize cure rates without compromising long-term functional outcome. Neuropsychological assessments with a focus on memory recall should be a component of the management of each case