Skip to main content

Advertisement

Log in

Surgery for craniopharyngioma

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Craniopharyngiomas are rare benign sellar region tumors, which are diagnosed either in childhood or adolescence due to local mass effects on visual pathways, pituitary and hypothalamus, or because of an increased intracranial pressure resulting from obstructive hydrocephalus. The neurosurgeons challenge is to achieve tumor control without aggravating the symptoms. There are essentially two different surgical philosophies. Although only gross tumor resection has been proven to provide cure, the accompanying surgical hazard is substantial. Thus, less aggressive operations with partial or subtotal tumor resection or drainage of cystic portions followed by irradiation may relieve the patient’s symptoms and benefit the patient more than a heroic tumor resection—since to date several variants of radiation therapy are available which also serve to control tumor progression. In the present brief review, the surgical techniques and outcomes of operations in craniopharyngiomas with special focus on the resulting morbidity and mortality are summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rutka JT (2002) Craniopharyngioma. J Neurosurg 97(1):1–2; discussion 2

    Google Scholar 

  2. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89(4):547–551

    Article  PubMed  CAS  Google Scholar 

  3. Karavitaki N, Cudlip S, Adams CB, Wass JA (2006) Craniopharyngiomas. Endocr Rev 27(4):371–397

    Article  PubMed  Google Scholar 

  4. Cushing H (1932) Further concerning a parasympathetic center in the interbrain: VII. The effect of intraventricularly-injected histamine. Proc Natl Acad Sci USA 18(7):500–510

    Article  PubMed  CAS  Google Scholar 

  5. Honegger J, Tatagiba M (2008) Craniopharyngioma surgery. Pituitary 11(4):361–373

    Article  PubMed  Google Scholar 

  6. Matson DD, Crigler JF Jr (1969) Management of craniopharyngioma in childhood. J Neurosurg 30(4):377–390

    Article  PubMed  CAS  Google Scholar 

  7. Sweet WH (1976) Radical surgical treatment of craniopharyngioma. Clin Neurosurg 23:52–79

    PubMed  CAS  Google Scholar 

  8. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90(2):237–250

    Article  PubMed  CAS  Google Scholar 

  9. Pereira AM, Schmid EM, Schutte PJ, Voormolen JH, Biermasz NR, van Thiel SW, Corssmit EP, Smit JW, Roelfsema F, Romijn JA (2005) High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol (Oxf) 62(2):197–204

    Article  Google Scholar 

  10. Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97(1):3–11

    Article  PubMed  Google Scholar 

  11. Baskin DS, Wilson CB (1986) Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg 65(1):22–27

    Article  PubMed  CAS  Google Scholar 

  12. Chakrabarti I, Amar AP, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102(4):650–657

    Article  PubMed  Google Scholar 

  13. Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dorr HG (1992) Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37(3):189–196

    Article  PubMed  CAS  Google Scholar 

  14. König A, Lüdecke DK, Herrmann HD (1986) Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir 83(1):1–7

    Article  Google Scholar 

  15. Laws ER Jr (1980) Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52(5):661–666

    Article  PubMed  Google Scholar 

  16. Maira G, Anile C, Albanese A, Cabezas D, Pardi F, Vignati A (2004) The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg 100(3):445–451

    Article  PubMed  Google Scholar 

  17. Maira G, Anile C, Rossi GF, Colosimo C (1995) Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 36(4):715–724

    Article  PubMed  CAS  Google Scholar 

  18. Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87(1):44–51

    Article  PubMed  CAS  Google Scholar 

  19. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3):539–547; discussion 547–550

    Google Scholar 

  20. Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F (2006) The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59(1 Suppl 1), ONS75–83; discussion ONS75–83

    Google Scholar 

  21. Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S (2008) Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg 109(1):6–16

    Article  PubMed  Google Scholar 

  22. Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106(3):400–406

    Article  PubMed  Google Scholar 

  23. Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH (2012) Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 70(1):110–123; discussion 123–114

    Google Scholar 

  24. Kim EH, Ahn JY, Kim SH (2011) Technique and outcome of endoscopy-assisted microscopic extended transsphenoidal surgery for suprasellar craniopharyngiomas. J Neurosurg 114(5):1338–1349

    PubMed  Google Scholar 

  25. Hofmann BM, Hollig A, Strauss C, Buslei R, Buchfelder M, Fahlbusch R (2012) Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg 116(2):373–384

    Article  PubMed  Google Scholar 

  26. Patterson RH Jr, Danylevich A (1980) Surgical removal of craniopharyngiomas by the transcranial approach through the lamina terminalis and sphenoid sinus. Neurosurgery 7(2):111–117

    Article  PubMed  Google Scholar 

  27. Muller HL (2011) Consequences of craniopharyngioma surgery in children. J Clin Endocrinol Metab 96(7):1981–1991

    Article  PubMed  Google Scholar 

  28. Nimsky C, Ganslandt O, Hofmann B, Fahlbusch R (2003) Limited benefit of intraoperative low-field magnetic resonance imaging in craniopharyngioma surgery. Neurosurgery 53(1), 72–80; discussion 80–71

    Google Scholar 

  29. Backlund EO, Axelsson B, Bergstrand CG, Eriksson AL, Norén G, Ribbesjö E, Rähn T, Schnell PO, Tallstedt L, Sääf M, Thorén M (1989) Treatment of craniopharyngiomas—the stereotactic approach in a ten to twenty-three years’ perspective. Acta Neurochir 99(1):11–19

    Article  CAS  Google Scholar 

  30. Shi XE, Wu B, Fan T, Zhou ZQ, Zhang YL (2008) Craniopharyngioma: surgical experience of 309 cases in China. Clin Neurol Neurosurg 110(2):151–159

    Article  PubMed  Google Scholar 

  31. Duff JM, Meyer FB, Ilstrup DM, Laws ERJ, Schleck CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46(2):291

    Article  PubMed  CAS  Google Scholar 

  32. Hoffman HJ, De Silva M, Humphreys RP, Drake JM, Smith ML, Blaser SI (1992) Aggressive surgical management of craniopharyngiomas in children. J Neurosurg 76(1):47–52

    Article  PubMed  CAS  Google Scholar 

  33. Karavitaki N, Brufani C, Warner JT, Adams CBT, Richards P, Ansorge O, Shine B, Turner HE, Wass JAH (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol 62(4):397–409

    Article  CAS  Google Scholar 

  34. Elliott RE, Jane JA Jr., Wisoff JH (2011) Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69(3), 630–643; discussion 643

    Google Scholar 

  35. Liubinas SV, Munshey AS, Kaye AH (2011) Management of recurrent craniopharyngioma. J Clin Neurosci 18(4):451–457

    Article  PubMed  Google Scholar 

  36. Honegger J, Barocka A, Sadri B, Fahlbusch R (1998) Neuropsychological results of craniopharyngioma surgery in adults: a prospective study. Surg Neurol 50(1):19–28

    Article  PubMed  CAS  Google Scholar 

  37. Honegger J, Buchfelder M, Fahlbusch R (1999) Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg 90(2):251–257

    Article  PubMed  CAS  Google Scholar 

  38. Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73(1):3–11

    Article  PubMed  CAS  Google Scholar 

  39. Muller HL, Faldum A, Etavard-Gorris N, Gebhardt U, Oeverink R, Kolb R, Sorensen N (2003) Functional capacity, obesity and hypothalamic involvement: cross-sectional study on 212 patients with childhood craniopharyngioma. Klin Padiatr 215(6):310–314

    Article  PubMed  CAS  Google Scholar 

  40. Pierre-Kahn A, Recassens C, Pinto G, Thalassinos C, Chokron S, Soubervielle JC, Brauner R, Zerah M, Sainte Rose C (2005) Social and psycho-intellectual outcome following radical removal of craniopharyngiomas in childhood. A prospective series. Childs Nerv Syst 21(8–9):817–824

    Article  PubMed  CAS  Google Scholar 

  41. Symon L, Pell MF, Habib AH (1991) Radical excision of craniopharyngioma by the temporal route: a review of 50 patients. Br J Neurosurg 5(6):539–549

    Article  PubMed  CAS  Google Scholar 

  42. Fischer EG, Welch K, Belli JA, Wallman J, Shillito JJ Jr, Winston KR, Cassady R (1985) Treatment of craniopharyngiomas in children: 1972–1981. J Neurosurg 62(4):496–501

    Article  PubMed  CAS  Google Scholar 

  43. Katz EL (1975) Late results of radical excision of craniopharyngiomas in children. J Neurosurg 42(1):86–93

    Article  PubMed  CAS  Google Scholar 

  44. Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D, Shiminski-Maher T, Flamm ES, Epstein FJ, Miller DC (1994) Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 35(6), 1001–1010; discussion 1010–1001

    Google Scholar 

  45. Chiou SM, Lunsford LD, Niranjan A, Kondziolka D, Flickinger JC (2001) Stereotactic radiosurgery of residual or recurrent craniopharyngioma, after surgery, with or without radiation therapy. Neuro Oncol 3(3):159–166

    PubMed  CAS  Google Scholar 

  46. Minniti G, Saran F, Traish D, Soomal R, Sardell S, Gonsalves A, Ashley S, Warrington J, Burke K, Mosleh-Shirazi A, Brada M (2007) Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas. Radiother Oncol 82(1):90–95

    Article  PubMed  Google Scholar 

  47. Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M (1993) Craniopharyngioma—a long-term results following limited surgery and radiotherapy. Radiother Oncol 26(1):1–10

    Article  PubMed  CAS  Google Scholar 

  48. Regine WF, Kramer S (1992) Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys 24(4):611–617

    Article  PubMed  CAS  Google Scholar 

  49. Dekkers OM, Biermasz NR, Smit JW, Groot LE, Roelfsema F, Romijn JA, Pereira AM (2006) Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154(3):483–489

    Article  PubMed  CAS  Google Scholar 

  50. Riva D, Pantaleoni C, Devoti M, Saletti V, Nichelli F, Giorgi C (1998) Late neuropsychological and behavioural outcome of children surgically treated for craniopharyngioma. Childs Nerv Syst 14(4–5):179–184

    Article  PubMed  CAS  Google Scholar 

  51. Di Rocco C, Caldarelli M, Tamburrini G, Massimi L (2006) Surgical management of craniopharyngiomas—experience with a pediatric series. J Pediatr Endocrinol Metab 19(Suppl 1):355–366

    PubMed  Google Scholar 

  52. Yamada S, Fukuhara N, Oyama K, Takeshita A, Takeuchi Y, Ito J, Inoshita N (2010) Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery. World Neurosurg 74(2–3):320–330

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael Buchfelder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buchfelder, M., Schlaffer, SM., Lin, F. et al. Surgery for craniopharyngioma. Pituitary 16, 18–25 (2013). https://doi.org/10.1007/s11102-012-0414-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-012-0414-8

Keywords

Navigation