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Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

The significance of the majority of the factors influencing the recurrence rate (RR) of craniopharyngiomas remains unclear, and the management of this significance is controversial. The present study aimed to evaluate the influence of patient age and tumor topography on the RR, the efficacy of radiotherapy, and the safety of surgery for recurrences.

Methods

The RR was analyzed in 38 children (follow-up, 2–256 months [mean, 147.6]) and 63 adults (follow-up, 2–221 months [mean, 100.2]. The efficacy of 18 sessions of radiotherapy (13 patients) and the outcome of 52 secondary surgeries (37 patients) were evaluated.

Results

The RR reached 39.5 % in children and 22.2 % in adults (p = 0.053). After radical tumor removal, the RR in children (36.7 %) was significantly higher (p = 0.024) than that in adults (14 %). In children after radical removal of intraventricular and extraventricular craniopharyngiomas (IECs), the RR was higher (60 %; p = 0.071) than in extraventricular (intrasellar and suprasellar; purely suprasellar extraventricular) tumors (25 %). Radical removal of 50 % of tumors was achieved (73.1 % in children; 26.9 % in adults; p = 0.002) in 56.7 % of the first and 40.9 % of further recurrences. There was no early mortality after 52 surgeries; functional worsening (endocrine, 2; obesity, 2; visual, 3) occurred after 7/52 secondary surgeries. Recurrence occurred after 9/18 sessions of radiotherapy.

Conclusions

The RR was higher in children than in adults and in IECs relative to other topographic groups. Children with IECs represent a risk group. The efficacy of radiotherapy was inconclusive. Early detection of recurrences enabled safe excision with low morbidity.

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Acknowledgments

The study was supported by a grant from the Scientific Grant Agency of the Ministry of Education of the Slovak Republic and the Slovak Academy of Sciences (VEGA) number 1/1166/10. The authors would like to thank Dr. Ján Luha, PhD (Institute of Medical Biology, Genetics, and Clinical Genetics of Comenius University, Faculty of Medicine, Bratislava, Slovakia) for statistical evaluation of the data.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Derer’s Faculty Hospital, Comenius University, Limbová 5, 811 04, Bratislava, Slovakia

    Juraj Šteňo

  2. Department of Neurosurgery, Comenius University, Bratislava, Slovakia

    Ivan Bízik, Andrej Šteňo & Viktor Matejčík

Authors
  1. Juraj Šteňo
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  2. Ivan Bízik
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  3. Andrej Šteňo
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  4. Viktor Matejčík
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Correspondence to Juraj Šteňo.

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Comment

The authors have reviewed their series of 117 patients operated upon during the recent 20-year period from 1991–2010. In 106 of these patients, the surgery was for resection of primary tumor and in 11 was for recurrence. They were then able to follow 101 patients (38 children, 63 adults) for recurrence following their surgery. They note a higher recurrence rate in tumors that were incompletely removed, a finding that other authors have reported and is not surprising. However, the recurrence rate was also higher in children than in adults, and the authors have specifically noted that tumors located in the intraventricular and extraventricular location had a higher incidence of recurrence. I commend the authors on their careful review and follow-up of this series of tumors, and for adding to the knowledge of the risk factors for their recurrence.

WT Couldwell

Utah, USA

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Šteňo, J., Bízik, I., Šteňo, A. et al. Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management. Acta Neurochir 156, 113–122 (2014). https://doi.org/10.1007/s00701-013-1938-z

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  • DOI: https://doi.org/10.1007/s00701-013-1938-z

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