Surgical strategy and quality of life in craniopharyngioma

Management of childhood craniopharyngioma remains controversial. Aggressive primary surgery is associated with an increased risk of severe obesity, but hypothalamus-sparing surgery might increase the need for reoperation and/or irradiation. Nevertheless, hypothalamus-sparing strategies decreased occurrence of obesity—a risk factor for impaired quality of life—without increasing recurrence rates in a new study.

Key Points

• For craniopharyngioma without hypothalamic involvement, the treatment of choice is an attempt at complete resection with preservation of visual and hypothalamic function

• For craniopharyngioma with hypothalamic involvement, a radical neurosurgical strategy is not recommended in order to prevent severe sequelae; irradiation should be considered as an efficient salvage therapy

• Hypothalamic tumour involvement and neurosurgical hypothalamic lesions have a major negative effect on quality of life in children with craniopharyngioma, mainly because of hypothalamic obesity

• Childhood craniopharyngioma with initial hypothalamic involvement should be recognized as a chronic disease; constant monitoring of the consequences and medical resources available for treatment by experienced multidisciplinary teams is required