Craniopharyngioma Total or Near Total Surgical Resection: An outcome based learning experience

Abstract

Background: Craniopharyngiomas are benign slow growing tumours that are located within the sellar and para sellar region of the central nervous system. It is a rare but significant health problem in Pakistan. The point prevalence of this tumour is approximately 2/100,000. Objective: To determine the outcome of complete resection in patients with craniopharyngioma and to determine the relationship of different factors with outcome at 3 months of follow up. Methods: A case series study conducted in thirty five patients, who were diagnosed as cases of craniopharyngioma on the basis of history, clinical examination, CT and MRI appearances and histopathological examination. All patients underwent complete resection of craniopharyngioma. The study was conducted at the Department of Neurosurgery, Dow University of Health Sciences/ Civil Hospital, Karachi from 27thth December, 2006 and 27th December, 2007. Results: Good outcome was seen in thirty four (97%) patients, one (3%) had poor outcome in term of mortality. Age, Preoperative presence of neurological deficit, localization of the lesion and preoperative hydrocephalus just before placement of VP shunt and radical excision were the most important predictor of good outcome. The rest of factors studied such as Glassgow coma, duration of illness, and signs of meningeal irritation postoperative hydrocephalus had no effect on outcome. Conclusion: A complete excision of the tumour is recommended, if there is no hypothalamic invasion and in the presence of hypothalamic invasion, near total resection with post-operative radiotherapy. Endocrine disturbances need careful follow up and replacement. Key Words: Craniopharyngioma, Radiotherapy, Sellar And Para Sellar Region, Complete Resection, Outcome.