title: Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series.
abstract: OBJECTIVE
  Craniopharyngioma accounts for 2%-5% of all primary intracranial neoplasms. The optimal management of craniopharyngioma remains controversial. The authors evaluated the early results of surgery and the longterm risk of tumor recurrence in a large series of patients undergoing resection of craniopharyngiomas.
  
  
  METHODS
  Between 1990 and 2008, 112 consecutive patients (57 male and 55 female patients with a mean [± SEM] age of 33.3 ± 1.8 years) underwent resection of craniopharyngiomas at the authors' hospital. Recurrence or growth of residual tumor tissue during follow-up was assessed using MR imaging.
  
  
  RESULTS
  There were 3 perioperative deaths (2.7%). Severe adverse events were more frequent in patients who underwent operations via the transcranial route (37%) than the transsphenoidal approach (5.6%; p < 0.001). Magnetic resonance imaging showed radical resection of the tumor in 78 (71.6%) of the remaining 109 patients. Previous surgery and maximum tumor diameter were associated with persistence of disease after surgery. Craniopharyngioma recurred in 26 (24.5%) of 106 patients. Presence of residual tumor on the first postoperative MR imaging, male sex, and no postoperative radiation therapy were associated with a risk of tumor recurrence. Quality-of-life data were assessed in the 91 patients who attended the authors' institution for follow-up visits. Among them, 8.8% patients were partially or completely dependent on others for daily living activities before surgery. This percentage increased to 14.3% at the last follow-up visit. The 5- and 10-year overall survival rates were 94.4% (95% CI 90.0%-98.8%) and 90.3% (95% CI 83.4%-97.3%), respectively.
  
  
  CONCLUSIONS
  Complete surgical removal of craniopharyngioma can be achieved with reasonable safety in more than 70% of patients. Recurrence of craniopharyngioma may occur even after apparent radical excision. Prompt management of residual or recurring disease by radiotherapy, repeat surgery, or a combination of both is usually successful in controlling further tumor growth.
authors.affiliation: Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Milano, Italy. mortini.pietro@hsr.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pozzobon
authors.forename: Raffaella
authors.initials: R
authors.lastname: Barzaghi
authors.forename: Marco
authors.initials: M
authors.lastname: Riva
authors.forename: Stefania
authors.initials: S
authors.lastname: Acerno
authors.forename: Diana
authors.initials: D
authors.lastname: Angius
authors.forename: Giovanna
authors.initials: G
authors.lastname: Weber
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiumello
authors.forename: Massimo
authors.initials: M
authors.lastname: Giovanelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D003397:Craniopharyngioma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003399:Craniotomy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011788:Quality of Life; D016634:Radiosurgery; D012086:Reoperation; D015996:Survival Rate; D014057:Tomography, X-Ray Computed