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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Outcome in surgical treatment of craniopharyngiomas and benefit of 1.5T intraoperative MRI resection control

Ergebnisse nach Resektion von Craniopharyngiomen und Nutzen der intraoperativen Resektionskontrolle mit dem Hochfeld-MRT (1,5T)

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  • corresponding author B.M. Hofmann - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • A. Höllig - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • J. Kreutzer - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • C. Nimsky - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • M. Buchfelder - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • R. Fahlbusch - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.01.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc164.shtml

Published: May 8, 2006

© 2006 Hofmann et al.
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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. The aim of this study is to discuss our current treatment strategy and to evaluate the effect of intra-operative MRI resection control. Therefore, the rates of complications, of total tumor removal (TRR) and recurrence (RR) after extended surgery are depicted and compared to radiotherapy.

Methods: 68 patients underwent surgery with the intent of total tumor removal for a newly diagnosed craniopharyngioma between May 1997 and January 2005. The mean follow-up was 24.5 months. Open surgery was only performed if no hypothalamic damage was present. Otherwise cyst aspiration or medical pre-treatment was performed.

Results: 50 patients were operated without intra-operative MRI control. The main treatment was transsphenoidal surgery in 19 patients (TRR 84.2%, RR 5.6%), a frontotemporal approach was used in 10 patients (TRR 70.0%, RR 14.3%) and a subfrontal approach in 21 patients (TRR 90.5%, RR 15.8%). Within this group of the TRR was 84.0% (42/50) and the RR was 11.9% (5/42). 18 patients were operated with intraoperative MRI resection control. The main treatment was transsphenoidal surgery in 8 patients (TRR 87.5%, RR 0%), a frontotemporal approach was used in 1 patient (TRR 100%, RR 0%) and a subfrontal approach in 9 patients (TRR 77.8%, RR 0%). In the latter group a combination with a transsphenoidal and a transventricular approach was used in 1 patient, each. Within this group the TRR was 83.3% (15/18). There were no recurrences observed. In 5 patients intra-operative consequences were drawn from intra-operative MRI.

Conclusions: Open surgery with the goal of total tumor removal remains the treatment of choice in most patients, since the results of radiotherapy are comparable or worse. Previous stereotactic cyst aspiration may necessary to improve the patient's condition. A subfrontal approach is promising better results than the frontolateral one. In case of tumor or capsule remnants radiosurgery should follow. Intraoperative MRI resection control is helpful in order to discover residual tumor in exceptional cases.