A Single Surgeon Single Center Surgical Experience with 127 patients of Craniopharyngioma

Résumé

Introduction: Craniopharyngiomas are benign neuroepithelial tumours of dysembryogenic origin with a bimodal age distribution and present with significant therapeutic challenges. Surgical resection remains the mainstay of the management. The purpose of this study was to analyze the experience with 127 consecutive craniopharyngioma patients operated at P.D. Hinduja Hospital, Mumbai by the senior author over the past 28 years. Material and Methods: Patients’ medical data were retrospectively reviewed from electronic medical records database. There were 33 (26%) patients under the age of 12 yrs and 94 (74%) above the age of 12. The male-to-female ratio was 86 to 41. The commonest presenting symptoms in both age groups were vision disturbances (58%) and raised ICP symptoms (42%). Hormonal disturbance was seen 24%. Other than 1 patient, all patients were followed up for at least 1 year. (Range 1-17 years) Median follow up in our series was 4.4 years. The total number of surgeries were 175. Results: Transcranial and endonasal approaches were used in 88% and 12%, respectively. The majority of the patients had gross total excision. 34% of patients had postoperative hormonal imbalance. Diabetes insipidus was seen in 25% of patients. CSF leak was 30 and 0 percent in endonasal and transcranial procedures, respectively. Postoperatively, vision improved in 85 percent of patients and remained stable in the rest. The recurrence rate was 24 percent. Redosurgery was carried out in 48 patients. Follow up radiation therapy and Gamma Knife radiosurgery were done in 20% and 9%, respectively. There was no postoperative mortality. Conclusion: Transcranial radical resection achieved a good outcome in most cases of craniopharyngioma in adults. The recurrence rate was 24 percent despite radical resection. Hence long-term follow up and adjunct radiation may be required.