2025 Proffered Presentations
S105: THE CHANGING PARADIGM IN CRANIOPHARYNGIOMA MANAGEMENT: A COMPREHENSIVE INSTITUTIONAL ANALYSIS
Ishan Kanungo, MD1; Wesley Shoap, MD2; Daniel Quintana, BS1; Christian Jimenez, BS1; Rithvik Ramesh, BA1; Sandeep Kunwar, MD3; Lewis Blevins, MD1; Manish Aghi, MD3; Phil Theodosopulos, MD3; Michael McDermott, MD3; Ezequiel Goldschmidt, MD, PhD3; 1University of California San Francisco School of Medicine; 2LSU New Orleans Department of Neurosurgery; 3University of California San Francisco School of Medicine Department of Neurosurgery
Introduction: Craniopharyngiomas are highly recurrent surgically challenging tumors due to their close association with critical neurovascular structures. The treatment paradigm has shifted from transcranial microsurgery (TCM) towards endoscopic endonasal approaches (EEA) sometimes paired with adjuvant therapies. Despite this trend, key management concepts remain disconnected.
Methods: This retrospective study analyzed 86 patients with craniopharyngiomas treated at a single institution. The impact of surgical strategy and adjuvant therapy was assessed on the resection grade, recurrence, endocrine, cognitive, and neurologic outcomes.
Results: The mean patient age was 33.2 (2-76) years and 57% were male. Headache (62.8%) and visual dysfunction (58.4%) were the most common presenting symptoms. Gross total resection was achieved in 55.8% of cases. There was no significant difference in recurrence rate between gross total resection (GTR) and subtotal resection (STR) (47.4% vs 29.2%, p=0.086, ChiSq). EEA did not differ from TCM in GTR (60% vs 50%, p=0.362), visual improvement (44% vs 41.7%, p=0.834), overall complications (36% vs 47.2%, p=0.301) or spinal fluid leak (8.3% vs 16%, p=0.3) while TCM had more infections (11.1% vs 0%, p<0.05) and more post-op antiepileptic drug use (27.8% vs 4.0%, p<0.05) than EEA. Finally, patients who did not receive adjuvant radiotherapy had significantly higher recurrence than those who did (51.1% vs 22.0%, p<0.05).
Conclusion: Adjuvant radiotherapy showed a significant impact on recurrence, while the extent of resection did not. Endonasal and open approaches can be used depending on tumor location and surgeon’s preference. Open approaches had a higher risk of infections and seizures.