Crniopharyngiomas

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Mortality rates following attempts at surgical removal of craniopharyngiomas have varied widely, and prohibitive rates often have been reported. In most contemporary series, the mortality rate is 5 percent or less. There is little doubt that total excision is the treatment of choice, if it can be achieved without injury to the patient. Excellent results with attempted radical removal are reported, including some series with zero mortality or a very low risk. Other workers regard craniopharyngiomas as malignant tumors because of their location and manner of growth and think that no forceful attempt at total extirpation should be made. They regard operation as merely palliative and believe that partial resection followed by radiation therapy should be the rule.

Subtotal or partial resection alone is rarely satisfactory treatment for these tumors, which are likely to recur over a period of time. Recurrence has a strong adverse affect on survival. Data indicate that less than 10 percent of both adults and children are still recurrence-free 10 years after subtotal removal. Craniopharyngiomas have been reported to be quiescent for years after partial resection, but most that are removed subtotally recur within a few years. Those tumors that are radically removed but recur do so after a much longer time interval. Patients with subtotal removal of the tumor will probably require further therapy by either radiation or reoperation.