Craniopharyngioma

With surgery, about 87% of patients have reported improvement in preoperative visual deficits, and many patients have reported improvement in preoperative endocrine deficits. Recurrence can occur but is rare in those who have undergone a complete resection. In those patients with residual disease, adjuvant radiotherapy or medical therapy can be considered, including dopamine, gonadotropin-releasing hormone, and somatostatin agonists. Radiation treatment runs the risk of affecting critical neighboring structures and does not have the advantage of significant cytoreduction. Stereotactic radiosurgery and stereotactic radiotherapy have improved the safety and effectiveness of irradiation.

Prolactinomas, on the other hand, respond well to medical therapy. Dopamine agonists can effectively normalize prolactin levels, normalize vision, and decrease tumor size in the majority of patients. Occasionally, the tumors are resistant to medical therapy, or patients are unable to tolerate them; in those cases, trans-sphenoidal surgery is advocated. Much interest has surrounded the role of medical therapy with growth hormone–secreting adenomas; however, no drug has been found to consistently reduce tumor volume by a significant amount.

Incidentally found pituitary adenomas are increasingly common. Conservative management is reasonable if the lesion is less than 10 mm and there is no evidence of neurologic and endocrinologic abnormalities.

Craniopharyngiomas can be treated either with surgery or a combination of surgery followed by radiotherapy. Surgery allows for a diagnosis, debulking of the tumor, and a chance of surgical cure. Radiation, either stereotactic radiotherapy or radiosurgery, is used to treat those incompletely resected tumors or those that have recurred after prior surgery. With modern advances in both the surgical and radiation fields, the risk of treatment-related side effects has improved, although survivors often have multiple hormonal deficiencies, pathologic obesity and disturbed sleep patterns from injury to the adjacent hypothalamus, permanent loss of peripheral vision, and disorders of memory and information processing.

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