Postoperative Outcomes for 28 Primary and Recurrent Craniopharyngiomas in Children

Introduction: Craniopharyngiomas are tumors of the sella that account for 6 – 9% of all pediatric brain tumors. Despite their benign pathology, they often cause significant morbidity due to hypothalamic dysfunction and optic interference. Treatment options typically include gross total resection (GTR) or subtotal resection (STR) followed with radiation; however, the optimal long-term approach remains debated. Objective: To report the demographics and outcomes of resection for previously unpublished pediatric craniopharyngioma patients at our institution. Methods: We conducted a retrospective analysis of 28 pediatric patients with pathologically confirmed adamantinomatous craniopharyngiomas, treated surgically between January 2007 and August 2024. Results: The mean age of presentation was 7.3 for primary craniopharyngiomas in comparison to 12.3 for the recurrent cohort ( p = 0.009). Of 28 pediatric patients, 10 (36%) had prior treatments at other institutions, including radiation (7), ommaya placement (6), STR (5), cyst drainage (4), GTR (1), or chemotherapy (1). No other significant demographic or tumor characteristic differences were observed between these groups. Five patients (18%) presented with hydrocephalus, and 10 (36%) were neurologically intact on presentation. There were 16 (57%) retrochiasmatic, 9 (32%) prechiasmatic and 3 (11%) complex craniopharyngiomas with a mean size of 3.4 cm (SD 1.5) in maximum diameter. Mean follow up was 109 months (SD 56). Twenty-five (89%) of the resections were performed via a frontal-orbital-zygomatical-temporal approach. In the patients who received their first treatment at our institution, 17/18 (94%) resections achieved GTRs compared with only 3/10 (30%) in the recurrent group (p =