Craniopharyngiomas

Craniopharyngiomas (CFGs) are rare, benign, extra-axial tumors of epithelial origin. They arise from the suprasellar region and involve the hypothalamic-pituitary axis, the optic pathways, the ventricular system, and the major intracranial blood vessels. Histopathologically, CFGs are divided into adamantinomatous (most common) and papillary subtypes. According to the site of origin and the growth direction, they may present with neuro-ophthalmological deficits, pituitary endocrinopathies, and mass effect on critical structures. Radical surgical removal via transcranial or transsphenoidal approach is the gold-standard treatment. When gross total removal (GTR) is not achievable, adjuvant radiation therapy through conventional radiotherapy (RT) or stereotactic radiosurgery (SRS) is employed to reduce recurrence risk. We present the results of our institutional experience of 196 patients treated between 2008 and 2021. According to lesion size, location, and relation to visual apparatus and critical vessels, a transcranial (54%) or a trans naso-sphenoidal (TNS) approach (39%) was advised. Gross-total resection was achieved in 80% of cases; otherwise, adjuvant SRS was employed. Postoperative endocrinopathies were mostly transient and easily treatable and a 12.8% rate of worsening of pre-existent visual deficit or visual disturbances of new onset was observed. At a mean 7-year follow-up, we have achieved a 95% OS and 85% recurrence-free survival.