Individualized treatment of pediatric craniopharyngiomas.
OBJECTIVE
The treatment of children with craniopharyngiomas should be individualized because of their heterogeneous clinical and radiographic characteristics. We performed this study to correlate the clinical and radiographic features at the time of presentation with the multimodality treatments the children received.


METHODS
Medical records were reviewed for children with craniopharyngiomas who presented to the Children's Hospital of Pittsburgh for their initial management between 1983 and 2004. Children were treated with microsurgical tumor resections (27), intracavitary irradiation with phosphorus 32 (32P) (12), and with gamma knife stereotactic radiosurgery (GKSR) (5).


CONCLUSIONS
There were no deaths in any treatment group. Gross total resections were thought to be performed in 18 patients and were confirmed by imaging in 13 of the 18 patients. The primary operative morbidities were hormonal and visual. Every child needed at least two replacement hormones and most had panhypopituitarism. Vision worsened postoperatively in 5 of 27 children. There was no operative morbidity or mortality from 32P. After 32P treatment, one child required a later cyst aspiration and one required a craniotomy for progressive cyst enlargement. There was no morbidity or mortality from GKSR, which achieved tumor stabilization or shrinkage in 4 of 5 cases. Resections, 32P, and GKSR are complimentary treatment modalities for children with craniopharyngiomas. Their indications and outcomes differ, but all should be available in the treatment armamentarium.
Albright
A Leland
AL
Department of Neurosurgery, Childrens Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. leland.albright@chp.edu
Hadjipanayis
Costas G
CG
Lunsford
L Dade
LD
Kondziolka
Douglas
D
Pollack
Ian F
IF
Adelson
P David
PD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008866:Microsurgery / Q000379:methods; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome