Repeat operations in pediatric patients with recurrent craniopharyngiomas

Background: Controversy continues over the optimal management of recurrent craniopharyngiomas. Our strategy for approaching repeatedly recurrent craniopharyngiomas in pediatric patients has been to decompress vital structures and relieve the symptoms as early as possible. The purpose of this study was to present our experiences of repeatedly recurrent craniopharyngiomas and the pattern of failure associated with treatment. Methods: A retrospective review was conducted on 7 pediatric patients who underwent resection >2 times in a single institution between 1990 and 2004. Resections were performed 3-8 times for each patient. Variables including tumor size, consistency and location, extent of resection, adjuvant therapy and morbidity were evaluated. Results: Thirty-two operations were performed in 7 pediatric patients. Total resection was not achieved by the third surgery and thereafter, and the interval between each surgery became shorter. Appetite disorders, neurocognitive disorders and behavioral disorders occurred following repeat surgeries. Conclusion: Repeat operations are associated with a high failure rate of tumor control, even though they can help relieve neurologic symptoms. It is suggested that the number of repeat operations should be limited.