Outcome of Radical Surgical Resection for Craniopharyngioma with Hypothalamic Preservation: A Single-Center, Retrospective Study of 1054 Patients.

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Outcome of Radical Surgical Resection for Craniopharyngioma with Hypothalamic Preservation: A Single-Center, Retrospective Study of 1054 Patients.

World Neurosurg. 2017 Feb 27;:

Authors: Shi X, Zhou Z, Wu B, Zhang Y, Qian H, Sun Y, Yang Y, Yu Z, Tang Z, Lu S

Abstract
OBJECTIVE: A retrospective review of the surgical outcome for patients with craniopharyngioma (CP) treated in a single neurosurgical center with surgical resection using visualization to ensure hypothalamic preservation.
METHODS: The study included 1054 patients. Prior to 2003, a pterional cranial approach was preferred for 78% of patients; after 2004, the unifrontal basal interhemispheric approach (UBIA) was performed in 79.1% of patients.
RESULTS: Complete tumor resection was achieved in 89.6% of patients; vision improved in 47.1% of patients who had preoperative vision impairment. However, diabetes insipidus (DI) worsened in 70.4% of patients and new-onset DI occurred in 29.7% of the remaining patients. Pituitary stalk (PS) preservation occurred in 48.9% of cases. There were 89.6% of patients with total tumor removal; 13.3% of patients showed tumor recurrence within an average of 2.8 years. Out of 69 follow-up patients with a subtotal or partial resection, 94.2% showed tumor recurrence within an average of 4.3 months. Of the total patients, 82.3% fully recovered.
CONCLUSIONS: This study has shown that radical surgical resection of craniopharyngioma using microsurgical excision can be effective with a good patient outcome without more limitations on each individual tumor of distinct features despite the recent endoscopic techniques' impact on CP surgery. The surgical approach depends on a direct and wider visualization of CP located in the midline with preserving hypothalamic structures by identifying some hypothalamic landmark structures. Following surgery, the majority of patients can resume their normal activities even after aggressive tumor removal, although patients will require postoperative hormonal replacement.

PMID: 28254603 [PubMed - as supplied by publisher]

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