Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Abstract

Background and objective Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. Material and methods The MEDLINE database was systematically reviewed (January 1970-February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. Results The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied This article is part of the Topical Collection on Pituitaries

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“…Craniopharyngioma represents about 5–10% of pediatric CNS tumors and 3% of intracranial tumors for all age groups, with peak incidences in the age categories of 5 to 9 and 40 to 44 years old. Approximately 40–87% of children will have at least one deficient hypothalamic-pituitary hormone at time of diagnosis [ 7 – 9 , 143 , 144 ]. Craniopharyngioma is primarily treated surgically, with or without adjuvant radiotherapy [ 7 , 8 , 143 ].…”

Proton therapy for craniopharyngioma in adults: a protocol for systematic review and meta-analysis

“…Open access tissues and enlarge the damage to tumours, which has achieved good results. [18][19][20][21] But the optimal management of craniopharyngioma remains controversial.…”

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

“…Craniopharyngiomas are benign tumors, originating either from squamous epithelial cell that rests in the Rathke's pouch, located along its path from the nasopharynx to the infundibulum, or as a result of squamous metaplasia from the pars tuberalis of the pituitary gland (1)(2)(3)(4). They constitute 2-4% of all intracranial tumors (3,(5)(6)(7)(8)(9)(10)(11)(12).…”