Clinical Characteristics and Surgical Results of Craniopharyngiomas in Adults and Children

Lee, Sun Ho; Min, Kyung Soo; Wang, Kyu Chang; Jung, Hee Won; Kim, Hyun Jib; Cho, Byung Kyu; Choi, Kil Soo; Han, Dae Hee

Abstract

The records of 59 patients with craniopharyngioma treated at the Department of Neurosurgery, SNUH, from Jan. 1981 to May 1990 were reviewed in order to compare the characteristics of the tumor in children and adults in view of clinical features, radiological findings, surgical results and follow-up outcome. This study was also done to evaluate the outcome and recurrence rate according to the extent of surgical removal between the two groups. Of the 59 patients, 22 patients were under the age of 15 and 37 patients were adults. In the child group the most frequent presenting symptoms were IICP symptoms(63.6%) followed by visual disturbance(27.3%) whereas visual disturbance(51.4%) were more often than IICP symptoms(24.3%) in the adult group. In the radiologic findings calcification(95.5%) and cystic change(95.5%) were more common in the children than the adults. In the adults calcification showed in 59.5% of patients and cystic change showed in 86.5% of patients. Hydrocephalus was noticed in 63.6% of the children whereas 16.2% of the adults showed hydrocephalus on the CT scan. Twenty-five operations were undertaken for 22 children and 39 surgical procedures were performed for 37 adults. Most of the surgical procedures were carried out by the pterional or subfrontal approach or a combined approach. Eighteen child patients and 12 adult patiens underwent total removal and 3 child patients sand 14 adult patients underwent subtotal removal. Surgical results were good in 33 adult patients and in 21 child patients. One patient died postoperatively after partial removal due to pulmonary embolism. The mean follow up period was 27.0 months in children and 22.6 months in adults. Clinical recurrence study with the subtotal and partial removal group revealed that recurrence happened more often and in a shorter period of time in children. Presumed factors influencing the total removal of tumor such as age, symptom duration, cysic protion, calcification, size and location of mass were analyzed. The total removal of the tumor is the best method of treatment, however, the recurrence rate in cases of subtotal removal and the morbidigy accompanying total removal, were also considered in planning the surgical treatiment.