Radiosurgery of Craniopharyngeomas in Combination with Stereotactic Methods

Czech version

Authors: T. Chytka ¹; R. Liščák ¹; V. Vladyka ¹; V. Dbalý ²; P. Štursa ³; M. Syrůček ⁴
Authors‘ workplace: Nemocnice Na Homolce, Praha ; Oddělení stereotaktické a radiační neurochirurgie ¹; Neurochirurgické oddělení ²; Radiodiagnostické oddělení ³; Oddělení patologické anatomie ⁴
Published in: Cesk Slov Neurol N 2008; 71/104(5): 565-575
Category: Short Communication

Overview

During 2/96–8/01 18 patients with craniopharyngioma were treated by stereotactic minimally invasive methods in our department at the Na Homolce Hospital and subsequently monitored for at least 5 years. The solid part of the craniopharyngioma was treated using gamma knife radiosurgery, the cystic parts of the tumor were treated with stereotactic aspiration or intracavitary brachytherapy. In a group of 18 patients (5 women, 13 men) treated with radiosurgery, the age varied from 7 to 73 (median 24) years. Fourteen patients underwent open partial resection before stereotactic radiosurgery (three patients were re‑operated), one patient underwent endoscopic partial operation, two patients had a shunt operation for their hydrocephalus, one patient underwent stereotactic biopsy, and one patient underwent external fractionated radiotherapy. The minimum marginal dose was in the range 12 to 35 (median 16) Greys, the median tumor volume was 3650 mm³. The follow up evaluation was 1–104 (median 61) months. Fifteen patients showed clinical improvement, three worsened clinically and died as a result of their tumour. Post‑radiation follow‑up imaging showed a reduction in tumour size in eleven patients (61 %) and no further tumour growth in 5 patients (27 %). One patient was found to have a larger tumour (6 %) 2 years after gamma knife treatment and this patient underwent repeated opened resection but died due to post‑operative complications. One patient had no follow up imaging, because he did not come for check–up, and died 7 months after gamma knife treatment. It is often necessary to apply a multidisciplinary approach in treating craniopharyngioma. If craniopharyngioma cannot be completely removed by means of surgery there are other treatment modalities, including stereotactic radiosurgery, that should be taken into consideration. Our results in a group of 18 patients proved the value of stereotactic radiosurgery as an adjuvant radiation treatment (15 patients), as an alternative to open surgery (3 patients) and the value of intracavitary irradiation radiosurgery (8 patients); in the case of one patient we show that it is possible to verify pathological diagnosis by stereotactic biopsy.

Key words:
craniopharyngioma – stereotactic surgery – intracavitary irradiation radiosurgery – stereotactic biopsy

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