title: Cystic Craniopharyngiomas: Microsurgical or Stereotactic Treatment?
abstract: BACKGROUND
  Prognosis and treatment of cystic craniopharyngiomas are poorly defined.
  
  
  OBJECTIVE
  To analyze progression-free survival (PFS) and safety profile of cystic craniopharyngiomas undergoing resection or minimally invasive drainage procedures. We compared further outcome measurements for cystic and solid tumors undergoing resection to elucidate the impact of the initial tumor composition on both PFS and the toxicity profile.
  
  
  METHODS
  All patients with craniopharyngiomas consecutively treated between 1999 and 2014 were included. A treatment decision in favor of microsurgery or stereotactic treatment was made interdisciplinarily. For stereotactic drainage, a catheter was implanted, allowing both permanent upstream (into ventricular spaces) and downstream (into prepontine cistern) drainage. Study endpoints were tumor progression, functional outcome, and treatment toxicity. Functional endocrinological and visual outcome analyses referred to data obtained preoperatively and 6 weeks after treatment. The Kaplan-Meier method was used for survival analysis. Prognostic factors were obtained from proportional hazard models.
  
  
  RESULTS
  Seventy-nine patients were included. The distribution of clinical and tumor-related data was well balanced among patients with solid (n = 35) and cystic (n = 44) tumors and those undergoing microsurgical or stereotactic treatment. Cystic tumors had shorter PFS (5-year PFS: 53.6% vs 66.8%, P = .10) and needed significantly more therapeutic interventions, which was independent of the initial treatment mode. The endocrinological deterioration rate was high for both solid and cystic tumors after microsurgery (59.4% and 85.7%, respectively), whereas it was significantly lower for cystic tumors undergoing stereotactic treatment (23.1%, P < .001).
  
  
  CONCLUSIONS
  Stereotactic bidirectional drainage of cystic craniopharyngiomas is effective and provides a better endocrinological outcome than conventional microsurgery.
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Rachinger
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Oehlschlaegel
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Kunz
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Fuetsch
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schichor
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Thurau
authors.affiliation: Medi-zinische Klinik und Poliklinik IV, Ludwig-Maximilians University, Mu-nich, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.affiliation: Department of Neuroradiology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Seelos
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Jörg-Christian
authors.initials: JC
authors.lastname: Tonn
authors.affiliation: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Kreth
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000000981:diagnostic imaging* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods / Q000592:standards*; D012042:Registries; D016896:Treatment Outcome
keywords: Craniopharyngioma; Cystic; Drainage; Microsurgery; Stereotactic