Article
Stereotactic treatment options in pediatric craniopharyngiomas
Stereotaktische Behandlungsmöglichkeiten bei Kindern und Jugendlichen mit Kraniopharyngiomen
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Authors
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T. Schubert
- Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg
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M. Trippel
- Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg
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C. B. Ostertag
- Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg
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G. Nikkhah
- Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg
| Published: | May 30, 2008 |
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Outline
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Objective: Treatment options for children with craniopharyngiomas range from radical resection to less invasive, stereotactic approaches. Parameters predicting the long-term outcome after treatment have not been defined. For this study a cohort of pediatric patients with craniopharyngiomas was investigated that were treated with different combinations of stereotactic approaches and microsurgical resection (MSR).
Methods: We retrospectively analyzed the data of 36 children (mean age 9,1 years, mean follow-up (FU) 16 months, still under investigation) treated in our department between 1990 and 2006. All tumours except one had a cystic component. The initial approach included stereotactically (STX) guided biopsy and cyst punction in 15 children. In 20 patients, only cyst punction was performed. One solid tumour was biopsied.
Following STX guided cyst drainage 16 patients underwent MSR and seven received fractionated external beam radiation (ERTX). Two patients were treated by STX cyst drainage only. In one patient Iodine-125 brachytherapy was performed. Four children received STX cyst drainage later in their treatment course.
Results: In the patient group treated by STX cyst drainage and MSR (mean FU: 42.2 months) postoperative outcome was as follows: Visual deficiency (V.D.) was preoperatively present in 10 patients (62.5%), improved in 4 pat. (25%), worsened in 6 (37.5%). Endocrine dysfunction (E.D.) was preoperatively present in all patients, improved in none, worsened in 10 (62.5%). Tumour recurrence (T.R.) occurred in 12 patients (75%). In the patient group treated with STX cyst drainage and ERTX (mean FU: 72 months) V.D. was preoperatively present in 5 patients (71.4%), improved in 4 patients (57.1%), worsened in one (14.3%). E.D. was preoperatively present in 3 patients (42.9%), improved in one (14.3%), worsened in two (28.6%). T.R. occurred in 2 patients (28.6%). One child treated with STX drainage (FU:71 months) received two additional cyst punctions within the first year of FU and had no further cyst recurrence, one is lost to FU. The patient treated by Iodine-125 brachytherapy (FU: 117 months) showed neither symptomatic worsening nor tumour recurrence.
Conclusions: Pediatric patients with craniopharyngiomas can benefit greatly from minimal invasive approaches offered by stereotactic techniques resulting in a good tumour and cyst control rate combined with a low morbidity.
