Neurosurgical treatment strategies in childhood   craniopharyngiomas: is less more?
OBJECTIVE
Craniopharyngiomas in children are typically present in combination with heterogeneous clinical and neuroradiological findings. It has remained highly challenging to choose the optimal treatment strategy with regard to local tumor control and clinical outcome. Here, we analyze different treatment methods and evaluate the results.


METHODS
We performed a detailed retrospective evaluation of 32 children <18 years old treated for craniopharyngioma between 1990 and 2008 at the University Hospital Freiburg. Three patient groups could be identified: children treated with microsurgical resection (n=17), with stereotactic cyst drainage and radiotherapy (n=7), and with various combined approaches (n=8).


RESULTS
Six of seven children treated with stereotactic cyst punction and radiation are still alive. All of them are in an age-appropriate neuropsychological condition. Two of seven patients in this group have tumor recurrences. Fourteen of the 17 children treated with microsurgical resection show tumor recurrences (p=0.02). Fifteen are alive, and ten out of 17 show an age-appropriate neuropsychological development. The 8.5 years freedom from progression differed from 24% in the resection group to 71% in the cohort treated with stereotactic cyst drainage and radiotherapy (p=0.05). In the third group treated with various approaches, three of eight patients were treated for cystic recurrence. The average follow-up is 5.5 years.


CONCLUSIONS
Based on our nonrandomized retrospective monocentric analysis, patients treated with less invasive stereotactic and radiotherapeutical methods have a more favorable long-term clinical outcome compared to children treated with a more radical microsurgical approach. Due to the possible implications of these results, further prospective trials should be encouraged.
Schubert
Tilman
T
Department of Stereotactic and Functional Neurosurgery, Neurocenter, University Hospital Freiburg, Freiburg, Germany. TSchubert@uhbs.ch
Trippel
Michael
M
Tacke
Uta
U
van Velthoven
Vera
V
Gumpp
Vera
V
Bartelt
Susanne
S
Ostertag
Christoph
C
Nikkhah
Guido
G
D000293:Adolescent; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003397:Craniopharyngioma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003560:Cysts / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome