Published in:
01-08-2005 | Special Annual Issue
Craniopharyngiomas of childhood: the CHLA experience
Published in: Child's Nervous System | Issue 8-9/2005
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Objective
To improve the outcome of children with craniopharyngiomas by analyzing how they were treated.
Methods
The records of patients who underwent operation at Childrens Hospital of Los Angeles (CHLA) from 1993 to 2004 were reviewed.
Results
Identified were 19 girls and 16 boys with an age range from 9 days to 16 years (mean 7 years, mode 3 years). Tumor control was achieved in 34 of 35 patients and was accomplished with reasonable outcome in terms of neurological deficits and overall level of function. In 25 patients, complete tumor resection was obtained with surgery alone, 18 with the first resection, and 7 with repeat operative intervention. Nine children received radiation therapy after the first or second recurrence. On retrospective review, there were no consistently identifiable features that would lead one to determine preoperatively which tumors would fall into a given category.
Conclusion
We believe that the surgeon must determine a preoperative plan that maximizes the chance for a gross total removal of the craniopharyngioma. The biggest challenge intraoperatively is to determine whether to continue with the attempt at gross total removal or stop short of that goal before producing a significant irreversible neurological deficit. A staged removal using different operative corridors also needs to be considered.