A Study of the Results of Microsurgical Resection with Radiosurgery in Management of Craniopharyngioma

Abstract

Craniopharyngiomas are histologically benign tumors originating from embryonic epithelial cells deposited along the incompletely involuted hypophyseal-pharyngeal duct. Approximately 60 % of these lesions are primarily solitary cysts, 30 % have small neoplastic nodules with one or more cysts, and 10 % are solid. Their management has been controversial. Attempted complete surgical resection can result in signi- ficant morbidity and mortality especially at facilities with a low case load. Alternatively, subtotal resection followed by conventional radiotherapy may lead to comparable outcomes while maintaining a good quality of life. Particularly, the volume of cystic caniopharyngiomas can be easily reduced using various surgical techniques, including neuroendoscopic fenestration or stereotactic aspiration, with subsequent irradiation of the collapsed lesion. Nevertheless, still there are serious concerns considering possible post treatment complications because of exposure of the peritumoral vital structures to irradiation. Since the advent of radiosurgery, precise stereotactically guided radiation treatment has been applied to primary or residual intracranial tumors while sparing the surrounding tissues by a steep dose falloff outside the target volume. In the present study, we evaluated the efficacy and safety of the use of Gamma Knife Radiosurgery (GKS) along with microsurgical resection in the management of craniopharyngioma. Forty patients (12children and 28 adults) with craniopharyngioma were treated with GKS between May 2005 to July 2012. The age of the patients ranged in our cases form 10 years to 62 years mean age (23 years). There were 18 males and 22 females. Craniopharyngiomas were solid in 13patients, cystic in10, and mixed in16. Tumor size ranged from 0.6 to 14cm 3 (mean4.16 cm3). The prescription dose ranged from 9.5 to 16 Gy (mean 12.2Gy). Maximum dose ranged from 19 to 32 Gy (mean 24.2 Gy) the mean dose to the visual pathways was 8 Gy (range 7.2–12.5 Gy). Before GKS 21 patients underwent subtotal resection of the neoplasm, 13 partial excisions and 4 stereotactic aspiration of the neoplastic cyst content. The length of follow-up period varied from 6 to 24 months (mean 16 months). The tumor control rate were 85%. Clinical outcome was considered excellent in 18 cases, good in 12, fair in 6 and poor in 4. No one patient with normal pituitary function before GKS developed hypopituitarism thereafter neither Deterioration of the visual function after treatment was noted in any patient. The overall conclusion is that Gamma Knife radiosurgery may provide good tumor control and improve the quality of life of adult and pediatric patients with a craniopharyngioma. It may play a significant role in the management of such tumors in combination with other treatment options, such as microsurgery, and stereotaxy.