Stereotactic Radiosurgery for Craniopharyngiomas

Craniopharyngiomas are histologically benign neoplasms, but their location and tendency to adhere to adjacent critical neuro-vascular and endocrine structures often make initial and complete surgical management challenging. Moreover, due to the high recurrence rate, craniopharyngioma commonly occurs as a chronic disease requiring continued multidisciplinary monitoring to promptly identify and manage the serious morbidities associated with the tumor and its treatment. This chapter discusses the role of stereotactic radiosurgery (SRS) in the management of craniopharyngioma. Single-session SRS is typically used for treatment of craniopharyngiomas; hypofractionated SRS (i.e. 2–5 fractions) may be considered for selected cases. SRS appears to be a safe and effective treatment option for recurrent or residual craniopharyngiomas. SRS is associated with 5-year overall survival and progression-free survival rates of 75%–100% and 60%–97%, respectively, at low risk of SRS-related morbidity and mortality. SRS may be considered an upfront treatment for selected patients who are unable or unwilling to undergo surgical resection. Well-designed studies will prove helpful for evaluating the long-term results of SRS for craniopharyngioma.