Adult craniopharyngioma. Clinical, radiological presentation and outcome of management

OBJECTIVE: The objective of this study was to ascertain the patterns of clinical and radiological presentation and the outcome of management of adult patients with craniopharyngioma (CRF).

METHODS: A retrospective review of adult patients (>\= 18 years) with CRF treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the period January 1990 to December 2001. Fifteen children with CRF were excluded from the study.

RESULTS: There were 11 patients, 6 females (54.5%), and 5 males (45.5%); the mean age was 33.7 years (median 31). The main presenting symptoms were reduced vision in 82%, symptoms of raised intracranial pressure (ICP) in 36.4%, endocrinal problems in 36.4%, seizures in 9%, and hemiparesis in 9%. Radiological studies showed 72.7% of tumors had mixed solid and cystic components, calcification in all tumors, and ventricular dilatation in 3 patients, with 2 of them (18.2%) having ventriculo-peritoneal shunt. Eighty-two percent of patients had tumor excision through pterional craniotomy and 18% through subfrontal approach. Gross total removal was achieved in 3 patients (27.3%), and subtotal resection in 72.7%. Tumor recurred in 4 patients (36.4%). The outcome was good in 8 patients (72.7%); poor in one patient (9%), and 2 patients died (18%).

CONCLUSION: Adult patients with CRF had better surgical outcome than children, therefore, total resection of the tumor should be the goal of treatment as it offers the best chance of cure; however, it should not be at the expense of severe functional disability.