Surgical experiences of 45 consecutive craniopharyngiomas

Object: The aim of the present study was to assess the outcome of surgical management in 45 consecutive patients harboring craniopharyngiomas treated between January 1986 and December 2002. Methods: In 45 patients undergoing surgery, the transsphenoidal approach was most frequently adopted as the primary procedure (20 patients), followed by the interhemispheric trans-lamina terminalis approach (13 patients), and by the pterional approach (9 patients), and finally endoscopic surgery (3 patients). Total tumor removal was finally achieved in 32 patients (71.1%), subtotal removal in 13 cases followed by conventional radiotherapy or gamma knife radiosurgery. In 15 patients, more than two of the surgical treatments were required to accomplish total tumor removal. In 8 of these 15 cases, the tumor recurred after initial surgical treatment by another neurosurgeon after which the patient was referred to us. The operative mortality is zero in all 45 cases. One 4-yearold boy died suddenly one and half years after the final operation, caused by the parents' poor medical coverage. Postmortem examination revealed a small fragment of residual tumor sticking to the anterior hypothalamic wall. Conclusion: Total tumor removal, while avoiding hazardous intraoperative manipulation, provided favorable results and a high rate of long-term control in craniopharyngiomas. (C) 2003 Elsevier B.V. All rights reserved.