MANAGEMENT OF CHILDHOOD CRANIOPHARYNGIOMA - CAN THE MORBIDITY OF RADICAL SURGERY BE PREDICTED

Seventy-five children treated for craniopharyngioma between 1973 and 1 994 were studied to demonstrate which pre- and intraoperative factors were indicative of a poor outcome as defined by a quantitative assessm ent of morbidity. This involved a retrospective review of 65 patients and a prospective study of 10 patients focused on clinical details and cranial imaging and a follow-up ''study assessment'' of 66 survivors performed over the last 2 years. As part of the assessment, 63 patient s underwent magnetic resonance imaging with a three-dimensional volume acquisition sequence 1.5 to 19.2 years after initial surgery. Predict ors of high morbidity included severe hydrocephalus, intraoperative ad verse events, and young age (less than or equal to 5 years) at present ation. Predictors of increased hypothalamic morbidity included symptom s of hypothalamic disturbance already established at diagnosis, greate r height (greater than or equal to 3.5 cm) of the tumor in the midline , and attempts to remove adherent tumor from the region of the hypotha lamus at operation. Large tumor size, young age, and severe hydrocepha lus were predictors of tumor recurrence, whereas complete tumor resect ion (as determined by postoperative neuroimaging) and radiotherapy giv en electively after subtotal excision were less likely to be associate d with recurrent disease. Based on these findings, the authors propose an individualized, more flexible treatment approach whereby surgical strategies may be modified to provide long-term tumor control with the lowest morbidity.