gms | German Medical Science

Objective: The optimal treatment strategy in craniopharyngiomas is still under debate: cyst aspiration and radiotherapy versus extended surgery with the intent of total tumor removal. Technical advances like intraoperative MRI made the latter more feasible. Because of this and our current experience, we have modified our treatment strategy. The aim of this study is to discuss the functional outcome resulting from these changes.

Methods: A total of 73 patients underwent surgery for craniopharyngiomas between May 1997 and January 2005. In most cases total tumor removal was attempted and achieved in 83.1%. The approaches used were: 26 transsphenoidal, 11 frontolateral, 27 subfrontal and 1 transventricular. In 8 patients suffering from poor clinical or neuropsychological condition, only stereotactic cyst aspiration was carried out. The functional outcome was evaluated comparing pre- and postoperative ophthalmologic investigations as well as the result of endocrine and neuropsychological testing. The mean follow-up was 25.2 months.

Results: An improvement in pre-existing ophthalmologic deficits was observed in 73.3% of the patients following transsphenoidal and 88.6% following transcranial surgery. In the latter group deterioration of vision was observed in 5.7%. Neuropsychological deficits improved in 88.9%. No new deficits were observed. Endocrine function deteriorated more frequently following open surgery using the subfrontal approach (GH 12.8%, GON 28.7%, TSH 33.4%, COR 55.6%, diabetes insipidus 74.1%) than after frontolateral (GON 18.0%, GH 25.0%, TSH 27.1%, COR & diabetes insipidus 54.4%) or transsphenoidal (COR, TSH, diabetes insipidus 19.2%) approaches depending on the pre-existing deficits.

Conclusions: Open surgery with the goal of total tumor removal remains the treatment of choice if patients are in an acceptable clinical and neuropsychological condition. Stereotactic cyst aspiration is helpful to ameliorate ophthalmologic deficits and improve the patients’ condition. New endocrine deficits following radical surgery should be accepted since they are compensated by remarkably good ophthalmologic and neuropsychological outcome as compared to radiotherapy and can be adequately treated with hormonal replacement therapy.