Stereotactic radiosurgery for craniopharyngiomas

Background The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. We evaluated the long-term clinical and radiologic outcomes of Gamma Knife radiosurgery (GKRS) for craniopharyngiomas. Methods This retrospective study involved patients managed with GKRS for a...

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Bibliographic Details
Published in:Acta neurochirurgica 2021-11, Vol.163 (11), p.3201-3207
Main Authors: Pikis, Stylianos, Mantziaris, Georgios, Lavezzo, Karen, Dabhi, Nisha, Sheehan, Jason
Format: Article
Language:English
Subjects:
Clinical deterioration
Interventional Radiology
Medicine
Medicine & Public Health
Minimally Invasive Surgery
Neoplasia
Neurology
Neuroradiology
Neurosurgery
Original Article - Brain Tumors
Patients
Pituitary
Radiosurgery
Risk factors
Surgical Orthopedics
Survival
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Summary:Background The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. We evaluated the long-term clinical and radiologic outcomes of Gamma Knife radiosurgery (GKRS) for craniopharyngiomas. Methods This retrospective study involved patients managed with GKRS for a craniopharyngioma during the period of 1989 to 2019. Patient clinical and radiologic data, tumor characteristics, and procedural details were analyzed. Results Thirty-eight consecutive patients (24 males; mean patient age at GKRS = 30.82 years [SD ± 20.45 years]) were treated with GKRS for craniopharyngioma. Overall survival rates at 5 and 10 years were 84.1% and 80.1%, respectively. Progression-free survival at 5 years was 48.1%, and, at 10 years, it was 29.8%. Risk factors for post-GKRS clinical deterioration were increasing number of isocenters used ( p  = 0.04 (HR1.32, CI 1–1.73)), increasing margin dose [ p  = 0.02 (HR1.52, CI 1.31–1.84)], and maximum dose > 35 Gy [ p  = 0.002 (HR1.35, CI 1.11–1.63)]. Conclusion Stereotactic radiosurgery (SRS) appears a safe and effective management option in selected craniopharyngioma patients. Increasing margin dose and maximum dose > 35 Gy are associated with an increased risk for post-SRS neurologic deficit. Further, well-designed studies are necessary to determine the optimal timing and SRS parameters and to identify which patients with craniopharyngioma will benefit the most from SRS.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-021-04990-1