Craniopharyngioma surgery

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Overview

Surgery is the mainstay of treatment for craniopharyngioma. Radical surgery is done either by transsphenoidal approach or by craniotomy. Recent studies propose subtotal resection with post operative radiotherapy as the management of choice for craniopharyngiomas, especially in the pediatric population. More advanced radiotherapy modalities currently under investigation include Gamma Knife and cyber knife radiosurgery.

Surgery

  • Surgery is the first-line treatment option for patients with craniopharyngioma, with or without radiation.
  • For treatment purposes, patients are grouped as having newly diagnosed or recurrent disease.[1]

Newly diagnosed craniopharyngioma

  • Treatment is individualized on the basis of factors that include the following: [2]
  1. Tumor size
  2. Tumor location
  3. Extension of the tumor
  4. Potential short-term and long-term toxicity

Recurrent craniopharyngioma

  1. Surgery
  2. Radiation therapy including radiosurgery
  • The management of recurrent craniopharyngioma is determined largely by previous therapy.
  • Repeat attempts at gross-total resections are difficult, and long-term disease control is less often achieved.
  • Complications are more frequent than with initial surgery.[2] [6]

References

  1. Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc
  2. 2.0 2.1 2.2 de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A (November 2007). "Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas". Neurosurgery. 61 (5 Suppl 2): 219–27, discussion 228. doi:10.1227/01.neu.0000303220.55393.73. PMID 18091236.
  3. 3.0 3.1 Fitzek MM, Linggood RM, Adams J, Munzenrider JE (April 2006). "Combined proton and photon irradiation for craniopharyngioma: long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital". Int. J. Radiat. Oncol. Biol. Phys. 64 (5): 1348–54. doi:10.1016/j.ijrobp.2005.09.034. PMID 16580494.
  4. Cohen M, Bartels U, Branson H, Kulkarni AV, Hamilton J (June 2013). "Trends in treatment and outcomes of pediatric craniopharyngioma, 1975-2011". Neuro-oncology. 15 (6): 767–74. doi:10.1093/neuonc/not026. PMC 3661103. PMID 23486689.
  5. Jalali R, Gupta T, Goda JS, Goswami S, Shah N, Dutta D, Krishna U, Deodhar J, Menon P, Kannan S, Sarin R (October 2017). "Efficacy of Stereotactic Conformal Radiotherapy vs Conventional Radiotherapy on Benign and Low-Grade Brain Tumors: A Randomized Clinical Trial". JAMA Oncol. 3 (10): 1368–1376. doi:10.1001/jamaoncol.2017.0997. PMC 5710529. PMID 28570730.
  6. 6.0 6.1 Elowe-Gruau E, Beltrand J, Brauner R, Pinto G, Samara-Boustani D, Thalassinos C, Busiah K, Laborde K, Boddaert N, Zerah M, Alapetite C, Grill J, Touraine P, Sainte-Rose C, Polak M, Puget S (June 2013). "Childhood craniopharyngioma: hypothalamus-sparing surgery decreases the risk of obesity". J. Clin. Endocrinol. Metab. 98 (6): 2376–82. doi:10.1210/jc.2012-3928. PMID 23633208.

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