SURGICAL-TREATMENT OF CRANIOPHARYNGIOMAS - AN EVALUATION OF THE TRANSSPHENOIDAL AND PTERIONAL APPROACHES

FIFTY-SEVEN PATIENTS WITH craniopharyngiomas underwent a total of 64 o perations. Their clinical follow-up ranged from 2.5 to 15.5 years, wit h a mean follow-up of 6.5 years. A transsphenoidal approach was used i n 35 patients (61 %), whereas 22 (39%) were operated on using a pterio nal approach (in 16 patients, the tumor was found in the suprasellar c isterns, and in 6, the tumor was found in the third ventricle and was removed passing through the lamina terminalis). Total removal of the t umor was achieved in 43 patients (75%). In six patients (11%), fragmen ts of the capsule remained attached to the hypothalamus (subtotal remo val), and, in eight patients (14%), the tumor was partially removed. N o recurrence occurred in those patients in whom removal was total. Reg rowth was observed in two patients (33%) in whom removal was subtotal and in two (25%) in whom removal was partial. Three of them underwent subsequent operations, and a total removal with good clinical outcome was achieved, All patients except two had good postoperative recovery. Twenty patients (35%) required hormonal replacement therapy. When tra nssphenoidal surgery was used, a total removal of the tumors was achie ved in 23 (66%) of the patients. Good clinical outcome was seen in all 35 patients. Six patients (17%) required hormonal replacement therapy . When the pterional approach was used for tumors in the suprasellar c isterns, we achieved total removal of tumors in 15 patients (94%). Goo d clinical outcome was seen in 20 patients (91%). Eleven patients (50% ) required hormonal replacement therapy. After a period of time (from 45 d to many years), three patients died, one because of a pulmonary e mbolism and two because of diencephalic insufficiency. Using the trans lamina terminalis approach, we achieved a total removal of intraventri cular tumors in five (83%) of six cases, with good clinical outcome in five; hormonal replacement therapy was necessary in three patients, a nd death caused by diencephalic insufficiency occurred in one patient after several months.