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J Neurol Surg B Skull Base 2022; 83(S 02): e545-e554
DOI: 10.1055/s-0041-1735559
Original Article

Comparison of Outcomes following Primary and Repeat Resection of Craniopharyngioma

Alexander A. Aabedi 
1   School of Medicine, University of California San Francisco, San Francisco, California, United States
,
Jacob S. Young
2   Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
,
Ryan R. L. Phelps
1   School of Medicine, University of California San Francisco, San Francisco, California, United States
,
Ethan A. Winkler
2   Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
,
Michael W. McDermott
3   Baptist Hospital, Florida International University, Miami, Florida, United States
,
Philip V. Theodosopoulos
2   Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
› Author Affiliations Funding None.
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Abstract

Introduction The management of recurrent craniopharyngioma is complex with limited data to guide decision-making. Some reports suggest reoperation should be avoided due to an increased complication profile, while others have demonstrated that safe reoperation can be performed. For other types of skull base lesions, maximal safe resection followed by adjuvant therapy has replaced radical gross total resection due to the favorable morbidity profiles.

Methods Seventy-one patients underwent resection over a 9-year period for craniopharyngioma and were retrospectively reviewed. Patients were separated into primary resection and reoperation cohorts and stratified by surgical approach (endonasal vs. cranial) and survival analyses were performed based on cohort and surgical approach.

Results Fifty patients underwent primary resection, while 21 underwent reoperation for recurrence. Fifty endonasal transsphenoidal surgeries and 21 craniotomies were performed. Surgical approaches were similarly distributed across cohorts. Subtotal resection was achieved in 83% of all cases. There were no differences in extent of resection, visual outcomes, subsequent neuroendocrine function, and complications across cohorts and surgical approaches. The median time to recurrence was 87 months overall, and there were no differences by cohort and approach. The 5-year survival rate was 81.1% after reoperation versus 93.2% after primary resection.

Conclusion Compared with primary resection, reoperation for craniopharyngioma recurrence is associated with similar functional and survival outcomes in light of individualized surgical approaches. Maximal safe resection followed by adjuvant radiotherapy for residual tumor likely preserves vision and endocrine function without sacrificing overall patient survival.

Keywords

craniopharyngioma - reoperation - endonasal - transcranial - maximal safe resection


Publication History

Received: 06 May 2021

Accepted: 25 July 2021

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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