Endocrine Abstracts

The treatment of craniopharyngiomas remains controversial, as no prospective randomized study has been performed. Although it is a benign tumour it may be life threatening because of its malignant growth and high recurrence rate. Compared to the general population, patients with this tumour has a 5-9-fold excess of mortality. The recurrence rate of the tumour seems to be dependent on the extent of tumour removal, the patient's age, and time of follow up. Primary radical surgery has been the first choice of treatment. Total removal of the tumour is not always possible and in some series burdened with 10% mortality rates. Radiotherapy as adjuvant therapy in sub-totally removed tumours, gives in some series a good long-term tumour control with 80-90% 10-year recurrence free survival rate. However, about 50% of craniopharyngiomas appear in childhood, which makes radiotherapy controversial. The extent of surgery seems to predict tumour recurrence, but total tumour removal, based on per-operative MRI, does not exclude tumour recurrence. In addition, there are some sub-totally removed tumours that do not recur. Unfortunately, reliable objective morphological criteria for prediction of tumour behavior in individual craniopharyngiomas are still lacking.
Recurrence operations, of craniopharyngiomas are burdened with a high morbidity and with a four-fold excess of mortality, compared to the general population. Whether the high morbidity in patients with large sub-totally removed craniopharyngiomas with adjuvant radiotherapy is caused by radiotherapy remains controversial.