Impact of maximal safe resection on the clinical outcome of adults with craniopharyngiomas

Recent studies suggest that subtotal resection (STR) followed by adjuvant radiation therapy is an appealing alternative to gross total resection (GTR) for craniopharyngioma, as STR provides similar tumor control without the associated endocrinological and behavioral morbidity. We have examined the impact of maximal safe resection on the clinical outcome of patients with craniopharyngioma. A total of 90 patients underwent surgical resection of craniopharyngioma at a single institution between January 1995 and April 2009. Sixty-one patients underwent GTR alone, four underwent GTR followed by adjuvant radiotherapy, 15 underwent STR alone, and 10 underwent partial removal followed by adjuvant radiotherapy. We analyzed and compared the clinical and endocrinological outcomes and radiological follow-up data of these patients. During the follow-up period, tumor recurrence following the initial resection occurred in 36 of 90 patients (40%). The repeat resection rate was higher in the STR group than the GTR group. Recurrence occurred in 20 of 61 patients (32.8%) from the GTR alone group, in 11 of 15 patients (73.3%) from the STR alone group, and in five of 10 (50%) patients from the STR with adjuvant radiation, such as radiotherapy or stereotactic radiosurgery, group (p = 0.030). Maximal safe resection of craniopharyngioma leads to excellent local control. STR with adjuvant radiation therapy does not assure preservation of endocrine function, although it provides better local control than STR alone.