Endocrine Abstracts

Background: Craniopharyngioma is a rare epithelial tumor of the central nervous system, affecting both children and adults and associated with significant morbidity.

Objective: To study the postsurgical evolution of craniopharyngioma in adults after total or incomplete surgical resection.

Material and methods: We performed a retrospective review of craniopharyngioma patients evaluated in the National Institute of Endocrinology in Bucharest between 1998 and 2018.

Results: A total of 60 patients (39.62±15.6 years-old) diagnosed with craniopharyngioma were included. All underwent initial surgery (68.3% transcranial, 31.7% transsphenoidal approach). Gross total resection (GTR) was achieved in 21 cases (35%), in all the others maximal resection was attempted (non-GTR). Surgery led to anosmia (in 2 cases), CSF leak (3 cases), subdural hematoma (2 cases). After surgery 13 cases (21.66%) had cognitive impairment (2 with GTR, 11 with non-GTR), 14 (23.3%) had hypothalamic syndrome (diurnal sleepiness, appetite and memory dysfunction- present in 1 case with GTR, 13 with non-GTR), 27 cases (45%) reported lethargy (7 GTR, 20 non-GTR), 24 (40%) complained of headaches (6 GTR, 18 nonGTR). All these complications were significantly more frequent in cases with incomplete tumor resection compared to those with GTR: P=0.000; 0.000; 0.036 and 0.009, respectively.

Conclusions: Craniopharyngioma is a tumor associated with very significant morbidity. GTR should only be attempted when a low risk of neurologic injury is considered; for the rest of the cases limited tumor resection followed by irradiation of the remnant might be the safest approach.