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Shifting Strategies in the Treatment of Pediatric Craniopharyngioma

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Abstract

Purpose of Review

Craniopharyngiomas represent one of the most challenging diseases to treat. Despite their benign histology, and after many decades of surgical experience and technological advancements, there is still no clear consensus regarding the most effective management for this tumor. Due to their location and aggressive local characteristics, purely surgical approaches all too often result in unacceptable morbidity.

Recent Findings

Partial resection combined with radiation therapy results in similar control rates when compared to aggressive surgery, while also minimalizing the neuro-endocrinological morbidity.

Summary

In this manuscript, we describe the historical progression of the shifting strategies in the management of pediatric craniopharyngioma. Time has also altered our expectations for outcomes, evolving from purely morbidity and mortality to simple Glasgow Outcomes Scales, now to formal neuro-psychometric and quality of life data.

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Data Availability

All materials and data supported the findings of our study are available at online repository databases.

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Acknowledgements

We thank Mrs. Adina Sherer for her editorial assistance.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery and Pediatric Brain Institute, Dana Dwek Children Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel

    Segev Gabay, Jonathan Roth & Shlomi Constantini

  2. Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Thomas E. Merchant

  3. Department of Neurosurgery, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Frederick A. Boop

  4. Tel Aviv University, Tel Aviv, Israel

    Jonathan Roth & Shlomi Constantini

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All authors researched the data for the article and made substantial contributions to discussions of content. S.G., and S.C., wrote the manuscript. All authors reviewed and edited the manuscript before final submission.

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Key Points

• There is no consensus for the best management of pediatric craniopharyngioma. However, there is a shifting strategy toward a more conservative, hypothalamic-sparing, approach, emphasizing quality of life as a main goal.

• Limited surgical resection, coupled with post-radiation proton therapy, provides a similar control rate when compared to gross total resection, albeit minimizing morbidity.

• Pediatric craniopharyngioma patients require a multimodality team, and an individualized surgical-medical approach.

• Extensive experience is essential when evaluating treatment options; thus, management should be held and congregated in large regional referral centers of excellence.

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Gabay, S., Merchant, T.E., Boop, F.A. et al. Shifting Strategies in the Treatment of Pediatric Craniopharyngioma. Curr Oncol Rep 25, 1497–1513 (2023). https://doi.org/10.1007/s11912-023-01471-9

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