Long term results of multimodality treatment of craniopharyngioma in children

The management of craniopharyngioma has been controversial for years. We re view our 20 year experience in the treatment of paediatric craniopharyngiom a. Twenty-five patients were treated for craniopharyngioma at The Montreal Children's Hospital from 1972 to 1991. They included 15 males and 10 female s whose median age was 10 years. The initial clinical manifestations were r emarkable for a predominance of symptoms and signs related to intracranial hypertension, followed in frequency by visual and endocrinological deficits . Radiologically, there were five cystic craniopharyngiomas, one solid and 19 mixed. Several therapeutic approaches were used including stereotactic d rainage followed by radiotherapy or radiosurgery (three cases), transspheno idal removal (six cases) and subfrontal and/or pterional craniotomy for tot al (three cases) or partial (13 cases) removal, followed by radiotherapy in 10 cases. The follow up period averaged 11 years. Eight patients recurred, three after total and three after partial removal; none of these six patie nts had received radiotherapy. Two cases treated by stereotactic drainage r ecurred, one received adjuvant radiosurgery and the other conventional radi otherapy. Morbidity was lower, and quality of survival better, with more co nservative approaches. More conservative approaches in the management of cr aniopharyngioma are reasonable alternatives for treatment. Similar rates of disease control are observed with less morbidity and better quality of sur vival.