Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com New Techniques in Pediatric Surgery Horm Res Paediatr 2010;74:62–66 DOI: 10.1159/000309349 Surgical Management of Craniopharyngiomas in the Pediatric Population Gabriel Zada Edward R. Laws Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass., USA outcomes in children with CPs are obtained only by close, frequent monitoring and by developing a keen sense of judgment regarding the appropriateness, timing and ag- gressiveness of any particular intervention. Copyright © 2010 S. Karger AG, Basel Introduction Craniopharyngiomas (CPs) are epithelially derived, neoplastic lesions originating from squamous epithelial cell rests located along the axis of the primitive stomo- deum. Although they are histologically benign tumors, they remain a major source of long-term morbidity due to their locally invasive behavior and potential for recur- rence. In children, CPs comprise approximately 10% of all primary intracranial neoplasms [1, 2]. The most com- mon location in which CPs arise is the suprasellar region; however, they can also be encountered as purely intrasel- lar, third ventricular, or nasopharyngeal masses [3]. Headache and visual deficits are common clinical manifestations of these tumors occurring at any age. Be- cause of their intimate anatomical association with the developing hypothalamic-pituitary axis and infundibu- lum, CPs frequently present with endocrine-related symptoms and signs, which in children often include growth retardation, sexual retardation, and obesity [1, Key Words Craniopharyngioma  Craniotomy  Transsphenoidal  Hypopituitarism  Pediatric  Diabetes insipidus Abstract Background: Craniopharyngiomas (CPs) are benign, locally aggressive neoplasms that comprise approximately 10% of pediatric brain tumors. The role of surgical management for CPs is discussed in this review. Methods: A review of the goals and techniques associated with selected surgical ap- proaches for the treatment of CPs in the pediatric population is provided. Results: CPs may be a cause of significant mor- bidity in children, requiring long-term, multimodal manage- ment by a team of specialists in order to optimize patient outcomes. Surgical intervention for CPs remains an impor- tant component of treatment, and depends upon establish- ing realistic and well-defined goals prior to any operation. Many transcranial and transsphenoidal approaches are avail- able for approaching and resecting CPs. A summary of the rationale behind the timing and appropriateness of various surgical approaches, as well as associated benefits, pitfalls, and outcomes, is provided in this review. Conclusion: Con- sistent longitudinal management by an interdisciplinary team can alter the treatment course in patients with CPs from a debilitating, morbid or lethal condition to a chronic, survivable disease with functional adult livelihood. Excellent Received: January 15, 2010 Accepted: March 26, 2010 Published online: May 7, 2010 Gabriel Zada, MD Department of Neurosurgery, Brigham and Women’s Hospital 15 Francis Street, PBB3 Boston, MA 02115 (USA) Tel. +1 617 525 8371, Fax +1 617 734 8342, E-Mail gzada  @  usc.edu © 2010 S. Karger AG, Basel 1663–2818/10/0741–0062$26.00/0 Accessible online at: www.karger.com/hrp HORMONE RESEARCH IN PÆDIATRICS