Endocrine Abstracts

The craniopharyngioma is a benign tumor, curable but aggressive by its localization involving the vital and visual prognosis of the patients. Treated mainly by surgery associated with radiotherapy which allows high long-term survival but at the expense of significant side effects, it nevertheless poses a problem of therapeutic management. The aim of this study is to illustrate the therapeutic difficulties in the management of craniopharyngioma

Patients and Methods: 13 cases of craniopharyngiomas confirmed by hormonal and radiological investigations (cerebral CT and MRI of the pituitary region) are collected.

Results: Average age at diagnosis is 25, sex ratio: 1.6. The revealing symptoms of craniopharyngioma are mainly represented by the visual disturbances found in 38% of patients, headache in 30%, diabetes insipidus in 15%. Somatotropic insufficiency was found in 30% of the patients evaluated, gonadotropic insufficiency in 38%, corticotropic insufficiency in 53% and thyrotropic insufficiency in 53%; as for diabetes insipidus, 53% of patients suffer from it at the time of diagnosis The average size of the tumor varies from 19 to 29 mm. Therapeutically, 53% of patients underwent surgery, 3 patients received an injection of yttrium and 2 patients underwent a stereotaxic puncture. 2 ventriculoperitoneal leads have been put in place for the treatment of hydrocephalus. Simple monitoring is recommended in a patient. The postoperative morbidities are: 2 cases of diabetes insipidus, one case of breach with fever and a corticotropic deficit.

Discussion: The initial management of craniopharyngiomas depends on the clinical presentation. Signs of intracranial hypertension as well as progressive visual impairment require urgent neurosurgical treatment for hydrocephalus and/or decompression of the cystic portion or tumor. Craniopharyngioma surgery aims to have as much surgical excision as possible to remove as much of the tumor as possible and to decrease the rate of local recurrence. However, this extensive surgery is complicated by a high rate of mortality and morbidity without preventing a significant risk of recurrence since it can reach 62% at 10 years. Recurrences are one of the most common complications, thus posing management difficulties, Conventional radiotherapy being the elective treatment at this stage. Chemotherapy by injection of bleomycin and interferon alpha is reserved for cystic forms.

Conclusion: The management of craniopharyngioma requires multidisciplinary cooperation. Surgery remains the main treatment. The surgical intervention must attempt an optimal tumor reduction while respecting the integrity of the optical and hypothalamic structures. Early diagnosis remains the determining factor in prognosis