title: Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management.
abstract: BACKGROUND
  The significance of the majority of the factors influencing the recurrence rate (RR) of craniopharyngiomas remains unclear, and the management of this significance is controversial. The present study aimed to evaluate the influence of patient age and tumor topography on the RR, the efficacy of radiotherapy, and the safety of surgery for recurrences.
  
  
  METHODS
  The RR was analyzed in 38 children (follow-up, 2-256 months [mean, 147.6]) and 63 adults (follow-up, 2-221 months [mean, 100.2]. The efficacy of 18 sessions of radiotherapy (13 patients) and the outcome of 52 secondary surgeries (37 patients) were evaluated.
  
  
  RESULTS
  The RR reached 39.5% in children and 22.2% in adults (p = 0.053). After radical tumor removal, the RR in children (36.7%) was significantly higher (p = 0.024) than that in adults (14%). In children after radical removal of intraventricular and extraventricular craniopharyngiomas (IECs), the RR was higher (60%; p = 0.071) than in extraventricular (intrasellar and suprasellar; purely suprasellar extraventricular) tumors (25%). Radical removal of 50% of tumors was achieved (73.1% in children; 26.9% in adults; p = 0.002) in 56.7% of the first and 40.9% of further recurrences. There was no early mortality after 52 surgeries; functional worsening (endocrine, 2; obesity, 2; visual, 3) occurred after 7/52 secondary surgeries. Recurrence occurred after 9/18 sessions of radiotherapy.
  
  
  CONCLUSIONS
  The RR was higher in children than in adults and in IECs relative to other topographic groups. Children with IECs represent a risk group. The efficacy of radiotherapy was inconclusive. Early detection of recurrences enabled safe excision with low morbidity.
authors.affiliation: Department of Neurosurgery, Derer's Faculty Hospital, Comenius University, Limbová 5, 811 04, Bratislava, Slovakia, juraj.steno@fmed.uniba.sk.
authors.forename: Juraj
authors.initials: J
authors.lastname: Šteňo
authors.forename: Ivan
authors.initials: I
authors.lastname: Bízik
authors.forename: Andrej
authors.initials: A
authors.lastname: Šteňo
authors.forename: Viktor
authors.initials: V
authors.lastname: Matejčík
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult