Background/Aim
Craniopharyngiomas are benign, invasive tumours. Given their low incidence, contemporary data about treatment outcomes are limited. The Royal Melbourne Hospital (RMH) is a quaternary centre for adults with pituitary disease that performs a high volume of pituitary surgery, hence we investigated our experience over the last decade.
Methods
We audited outcomes for patients who underwent craniopharyngioma resection at RMH from 2010-2021, including: surgical approach, perioperative complications, residual disease, radiotherapy, diabetes insipidus (DI), hypopituitarism, hypothalamic dysfunction and mortality.
Outcomes
Eighteen patients underwent craniopharyngioma resection, performed by one surgeon. Common presenting complaints included visual disturbance (56%), hypopituitarism (39%) and headache (22%). The median age at diagnosis was 43 years (16-71). Six (33%) were diagnosed aged 16-20 and 9 (50%) aged 48-71, a bimodal distribution. Two underwent craniotomy and the remainder had an endoscopic endonasal transsphenoidal approach.
Fifteen (83%) had recurrence/residual disease; 6 underwent further surgery and 9 received radiotherapy. Thirteen have been stable on serial imaging.
Permanent vision loss was present in 2 (11%) patients. Two, age 66 and 76 are deceased, both with other comorbidities at the time of death.
DI occurred in 14 (78%) patients and was transient in 3 (21%). 3 (16%) were reported to have hypothalamic dysfunction. Seventeen (94%) had at least partial hypopituitarism post operatively; all requiring glucocorticoid and thyroxine replacement. Twelve (67%) patients required oestrogen/testosterone therapy and 2 (11%) were treated with growth hormone (GH) replacement.
Discussion
Our contemporary series resembles the limited published data, with a mean age of 36-43 years and primary presenting complaints of visual disturbance (67-75%) and hypopituitarism (42-60%)1. Post-operative rates of DI and hypopituitarism were also comparable. GH treatment rates were low, suggesting many may not have been tested for GH deficiency since PBS GH became available. The reported incidence of hypothalamic dysfunction was low with a modern surgical approach.