Endocrine Abstracts

Introduction: Craniopharyngiomas (CF)- benign epithelial tumors that develop from the remnants of Rathke’s pouch cells. Most often, CF manifest themselves in two age groups: in children 5–14 years old making 5.6–13% of intracranial tumors and in adults 50–74 years old making 2–5%.

Materials and methods: In the last decade, the Institute annually for the surgical treatment received 100–120 patients with CF. The total number of cases (given and repeated) exceeds 2500. For transcranial removal of CF we use different combinations of basal and transcallosal approaches. In pediatric patients this type of surgery reaches 60%, and in adult patients only 20%. Starting in 1987 we use transsphenoidal approaches (first microsurgically, from 2005 pure endoscopicaly). Extended endoscopic approach makes possible radical tumor removal. Now transsphenoidal operations for CF in pediatric group takes only 20%, instead 60% in adults. For cystic craniopharyngiomas in some cases, we use Ommaya systems. It takes 20% of both pediatric and adults group.

Results: In recent years, mortality in adults group after tarnscranial surgery does not exceed 8%, after transshenoidal and Ommaya system in both age groups mortality is zero. Tumor recurrence after total and subtotal removal takes 21.5%, and after a partial takes 53.2%. The recurrence rate of papilomatouse CF takes 7.8%. In the last decade we started using radiosurgery and stereotactic radiotherapy (“Gamma knife”, “Cyber knife”, “Novalis”). In cystic CF after irradiation we saw sharp reduction in production of cystic fluid. Nowadays we do not have sufficient statistics to estimate the effect of irradiation on the rate of tumor progression and the probability of formation of its recurrence, but we have the number of cases with significant reduction of tumor size.

Conclusion: Further development of a combined treatment of CF will be to improve surgical techniques such as endoscopic assistance in transcranial surgery and improvement of transsphenoidal endoscopic techniques. Future analysis of the effect of different variants of radiotherapy on recurrence rate will optimize surgical removal of CF, as well as irradiation regimes. Modern morphological studies will identify CF subgroups with the aggressive character of growth and a high risk of relapse.