title: Treatment-related morbidity and the management of pediatric craniopharyngioma: a systematic review.
abstract: OBJECTIVE
  Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric craniopharyngioma.
  
  
  METHODS
  The authors performed a systematic review of the published literature on pediatric craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment.
  
  
  RESULTS
  Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal resection (STR) was not associated with an increased rate of new neurological deficits. Gross-total was associated with increased rates of diabetes insipidus (OR 7.7, p = 0.05) compared with the combination of STR and radiotherapy (RT). The addition of RT to STR was associated with increased rates of panhypopituitarism (OR 9.9, p = 0.01) but otherwise similar rates of morbidities.
  
  
  CONCLUSIONS
  Although subject to the limitations of a literature review, this report suggests that GTR is associated with increased rates of endocrinopathies compared with STR + RT, and this should be considered when planning goals of surgery.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Tene A
authors.initials: TA
authors.lastname: Cage
authors.forename: Derick
authors.initials: D
authors.lastname: Aranda
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Kurtis I
authors.initials: KI
authors.lastname: Auguste
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects* / Q000379:methods*; D007018:Hypopituitarism / Q000209:etiology*; D007223:Infant; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010911:Pituitary Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult