Effect of Craniopharyngioma’s Degree of Resection on Long Term Hormonal Outcome

Craniopharyngiomas account for 5% of all tumors and 50% of all sellar-supra sellar tumors in children. Endocrinal disturbances can occur in 70% of children with craniopharyngioma. Objective: To evaluate the hormonal outcome after surgical intervention in craniopharyngioma patients. Methods: Prospective study included eighteen patients treated at Children’s Cancer Hospital Egypt from January 2010 to December 2011. Eleven males (61.1%); seven females (38.9%), age 2-18 years (mean=9.5 years). Full hormonal assay was performed for all patients on admission, immediate postoperatively and then every three months. Craniopharyngiomas were treated either by total excision (eight patients) or subtotal excision with subsequent adjuvant radiotherapy (ten patients). Assessment of endocrinal outcome in both surgical groups was performed. Results: Eight out of eighteen patients (44.4%) had total tumor excision. Ten patients (55.6%) had subtotal excision followed by conventional conformal radiotherapy in eight of them. Preoperatively, two patients had low cortisol level, eight patients had a low thyroid hormone, five patients had high prolactin level and one patient had low prolactin level. At18 months postoperatively, eight out of ten patients (80%) with subtotal excision had no endocrinal disturbance. Two patients (20%) received conventional radiotherapy and had endocrinal disturbance which needed hormonal replacement. Seven out of eight patients (87.5%) with total tumor excision had severe endocrinal disturbance and needed long-term hormonal replacement while only one patient (12.5%) had no hormonal disturbance. Conclusion: There is debate on the optimal treatment of craniopharyngioma. In nonfeasible tumors, Subtotal resection with adjuvant therapy gives better endocrinal outcome than radical resection in situations when craniopharyngioma is adherent to the surrounding neural structures especially hypothalamus and optic pathway.