title: Neuroendoscopy Followed by Radiotherapy in Cystic Craniopharyngiomas--a Long-Term Follow-Up.
abstract: BACKGROUND
  Treatment of cystic craniopharyngiomas is often complicated because of adherence of craniopharyngiomas to adjacent brain structures. A strategy involving neuroendoscopic procedures followed by stereotactic radiotherapy is less invasive, avoiding brain damage. However, long-term follow-up of this strategy has not been investigated in depth.
  
  
  METHODS
  Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration, followed by fractionated stereotactic radiotherapy (FSRT). The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents. FSRT was performed using 6 fixed beams, an 8-mm margin to cover the gross tumor volume with a 95% isodose line, and a target delivered dose of 50.4 Gy in 28 fractions.
  
  
  RESULTS
  The median follow-up period was 72.9 months. Tumor control was achieved in 8 of 9 patients (88.9%). Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone (26.1%) at 6 months (20.4%), 1 year (11.0%), and 2 years (3.1%). One recurrent case showed multilobulated cysts, and a second surgery was required 1 year after the treatment. Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure. No new visual disturbances, endocrinopathy, or hypothalamic dysfunction was observed during follow up.
  
  
  CONCLUSIONS
  Neuroendoscopic cyst aspiration and fenestration followed by FSRT is a less invasive, powerful strategy for treating adult cystic craniopharyngiomas.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. Electronic address: shingo4@md.tsukuba.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takano
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Akutsu
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizumoto
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D044583:Neuroendoscopy / Q000379:methods*; D010907:Pituitary Hormones / Q000097:blood; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013396:Suction; D014792:Visual Acuity
chemical_list: D010907:Pituitary Hormones
keywords: Cystic craniopharyngioma; Neuroendoscopy; Stereotactic radiotherapy