Introduction: Patients with craniopharyngioma are characterised by a high incidence of hypopituitarism, visual failure and hypothalamic dysfunction. Standardised mortality is markedly elevated and controversy exists about optimal treatment.
Aim: We aimed to examine the temporal trends in the treatment of craniopharyngioma at our centre. Also, we sought to examine treatment needs and long-term morbidity in this patient group.
Methods: We performed a retrospective review of all patients with craniopharyngioma currently attending the out-patient clinic at St Bartholomews Hospital. Data recorded include demographic, clinical, biochemical and radiological variables. Study period for date of diagnosis (19512013) was divided into quartiles and trend analysis performed using χ2-test.
Results: patients (25 male) were identified. Median age at presentation was 30.5 years (range 279); majority presented with symptoms from tumour compression. Median clinical follow-up 30 years (range 159). 46 patients underwent primary surgical treatment; 30 patients (64%) had surgery via the transcranial route. There was a significant temporal trend towards use of the transsphenoidal approach in the treatment of contemporary cases; P=0.02. 15% required repeat surgery for tumour recurrence; median time to recurrence was 3 years. 31 patients underwent post-operative external beam radiotherapy; 77% had immediate radiotherapy following the first operation while the remainder had radiotherapy for tumour recurrence. The majority (45/47) had multiple pituitary hormone deficiencies. 81% had cranial diabetes insipidus. Median current BMI was 30.02 kg/m2; 13% are treated for type 2 diabetes; 23% are treated for hypertension; 30% are treated for hyperlipidaemia. 24 patients (51%) had permanent visual impairment.
Conclusion: Patients with craniopharyngioma suffer from high rates of hypopituitarism, visual loss and an adverse metabolic phenotype. Further follow-up is required to determine the impact of contemporary treatment approaches on long-term morbidity.