Endocrinological outcomes of pediatric craniopharyngiomas with anatomical pituitary stalk preservation: preliminary study.
OBJECTIVE
We reviewed 17 pediatric craniopharyngioma patients, with a special focus on endocrinological outcomes and tumor recurrence with pituitary stalk preservation.


METHODS
From 1992 to February 2008, 17 patients underwent 27 surgical procedures. The male-female patient ratio was 12:5 and median patient age was 12 years (range, 4-18 years). The median follow-up period was 4.97 years (range, 1.16-15.08 years). The most frequent major presenting symptom was increased intracranial pressure (in 76.5%), followed by visual disturbance (in 23.5%). Tumors were totally removed in 70.6% of patients, subtotally removed in 23.5% and partially removed in 5.9%.


RESULTS
The postoperative visual improvement rate was 47.6% and the postoperative visual deterioration rate was 33.3%. In 7 patients with stalk preservation, 1 received partial hormone replacement and 6 received total hormone replacement. The overall tumor recurrence and re-growth rate were 52.9%. In patients who did not receive radiotherapy immediately after their first operation, the recurrence-free survival rate differed between those with pituitary stalk preservation and those with stalk section (p = 0.04). The recurrence rate was 60% (3 of 5) in the former and 33.3% (3 of 9) in the latter. Two patients who had undergone a second operation for recurrences died. The operative morbidity rate was 23.5%.


CONCLUSIONS
Pediatric craniopharyngiomas had high recurrence rates and low pituitary functional preservation despite anatomical stalk preservation. Therefore, maximal tumor resection might be more important than anatomical stalk preservation in pediatric craniopharyngiomas.
Jung
Tae-Young
TY
Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea.
Jung
Shin
S
Moon
Kyung-Sub
KS
Kim
In-Young
IY
Kang
Sam-Suk
SS
Kim
Jae-Hyoo
JH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D010902:Pituitary Gland / Q000502:physiology* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology