Craniopharyngiomas in Adults and Pediatric Patients

Background: The management of craniopharyngiomas is one of the most challenging treatment modalities in neurosurgery and often differs in adults and children. The aim of the study was to compare the results of surgical treatment and complications in adult and pediatric patient groups with craniopharyngioma. Material and Methods: During the period of 1994 to 2005, 19 children and 41 adult patients were treated for craniopharyngioma in the Neurosurgical Department of Kaunas Medical University Hospital. Different surgical methods were performed in 59 adult and 19 pediatric cases. Statistical analysis was used for evaluating the obtained data. Results: The most frequent symptom was headache. Three different surgical approaches were used: craniotomy (46 in adults, 13 in children), trans-sphenoidal surgery (in 3 and 2 cases, respectively), and stereotactic aspiration of tumorous cysts (10 and 3, respectively). The pterional approach was performed most frequently. Radical removal of the tumor was performed in 46% of adults and 47.4% of pediatric cases. Surgery for recurrent craniopharyngioma was performed in 29% and 21.1% of cases, respectively. Adjuvant radiotherapy was indicated in some cases after subtotal removal of tumor. One patient continued with intracavitary isotope treatment. Postoperative complications were revealed in 36% of adult and 73.7% of pediatric patients. Postoperative diabetes insipidus was diagnosed in 35.3% of adults and in 64.7% of children. The most troublesome complication among children was hypothalamic obesity (36.8% of patients). Four patients (2 adults, 2 children; 6.7%) died within some days after surgery. Conclusions: Craniopharyngioma was more frequent in females in adult patients and in boys among pediatric patients. The pterional approach ensured complete removal of craniopharyngiomas in more than 50% of cases. The most frequent complication was diabetes insipidus. It developed mostly after total removal of the tumor and was more frequent in children (p