Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas
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ORIGINAL ARTICLE - PEDIATRIC NEUROSURGERY
Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas Sauradeep Sarkar 1 & Shireen R. Chacko 2 & Sophy Korula 3 & Anna Simon 3 & Sarah Mathai 3 & Geeta Chacko 4 & Ari George Chacko 1 Received: 16 June 2020 / Accepted: 18 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas. Methods This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5–127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed. Results Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011). Conclusions Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up. Keywords Pediatric craniopharyngiomas . Long-term outcomes . Recurrence . Hypothalamic obesity
Abbreviations CI Confidence interval CT Computed tomography This article is part of the Topical Collection on Pediatric Neurosurgery Presentation at a conference: This paper was presented in part at the Annual Conference of the Indian Society for Pediatric Neurosurgery held in Kolkata from February 6-8, 2020. * Ari George Chacko [email protected] 1
Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
2
Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
3
Department of Pediatric Endocrinology, Christian Medical College, Vellore, India
4
Department of Pathology, Christian Medical College, Vellore, India
EOR GTR MRI NTR OR RT STR
Extent of resection Gross total resection Magnetic resonanc
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