title: Trends in treatment and outcomes of pediatric craniopharyngioma, 1975-2011.
abstract: BACKGROUND
  Craniopharyngioma tumors and their treatment can lead to significant long-term morbidity due to their proximity to vital structures. The optimal treatment has been debated for many years. We aimed to review the long-term outcomes of children treated for craniopharyngioma in our institution over the past decade and describe trends in treatment and outcomes over the past 3 decades.
  
  
  METHODS
  Charts of children with craniopharyngioma treated and followed at The Hospital for Sick Children between 2001 and 2011 were reviewed. Data regarding findings at diagnosis, treatment, and long-term outcomes were analyzed. Comparison was made with previously published data from our institution.
  
  
  RESULTS
  Data from 33 patients are included; mean age at treatment, 10.7 ± 4.8 years. In 18 children (55%), the initial surgical approach was tumor cyst decompression with or without adjuvant therapy, compared with only 0-2% in the preceding decades (P < .01). Diabetes insipidus occurred in 55% of children and panhypopituitarism in 58% compared with 88% (P < .01) and 86% (P < .01), respectively, in the previous 10 years. Overall, there was a 36% reduction in the number of children who developed severe obesity compared with the preceding decade. Body mass index at follow-up was associated with body mass index at diagnosis (P = .004) and tumor resection as an initial treatment approach (P = .028).
  
  
  CONCLUSIONS
  A shift in surgical treatment approach away from gross total resection has led to improved endocrine outcomes. This may have beneficial implications for quality of life in survivors.
authors.affiliation: Division of Endocrinology, The Hospital for Sick Children, 555 University Ave. Toronto, Ontario, Canada M5G1X8.
authors.forename: Michal
authors.initials: M
authors.lastname: Cohen
authors.forename: Ute
authors.initials: U
authors.lastname: Bartels
authors.forename: Helen
authors.initials: H
authors.lastname: Branson
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D060787:Neoplasm Grading; D009765:Obesity / Q000473:pathology; D010907:Pituitary Hormones / Q000172:deficiency; D010911:Pituitary Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D010907:Pituitary Hormones
keywords: craniopharyngioma; hypothalamic obesity; interferon alpha; intracystic chemotherapy; pediatrics