Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma.
Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson's chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33-41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ(2) P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05-5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available.
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117, USA.
Michael E
ME
Sughrue
Isaac
I
Yang
Ari J
AJ
Kane
Shanna
S
Fang
Aaron J
AJ
Clark
Derrick
D
Aranda
Igor J
IJ
Barani
Andrew T
AT
Parsa
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications / Q000532:radiotherapy / Q000601:surgery*; D004700:Endocrine System Diseases / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery*; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology; D055815:Young Adult