Surgical Management of Craniopharyngiomas

Craniopharyngiomas are benign yet locally invasive tumours of the sellar and suprasellar region that pose significant surgical challenges due to intimate relationships with the optic apparatus, pituitary stalk and hypothalamus. The primary goal of treatment is safe resection of tumour mass while preserving neurological, visual and endocrine function. Historically, open microsurgical approaches via transcranial or transsphenoidal routes have been employed to achieve gross total resection where hypothalamic invasion is minimal. In cases of hypothalamic encasement, a more conservative sub-total resection combined with postoperative radiotherapy has become standard in order to limit hypothalamic injury and its attendant morbidities. Advances in endoscopic endonasal techniques have expanded access to intrasellar and suprasellar lesions, offering improved visualisation and potentially reduced morbidity. Multidisciplinary collaboration among neurosurgery, neuro-ophthalmology, endocrinology and radiation oncology is essential to tailor the extent of resection, plan adjuvant therapies and manage long-term neuroendocrine sequelae. Emerging concepts include tumour volume reduction through targeted medical therapies prior to resection and refined radiotherapy modalities to control residual disease, with the ultimate aim of balancing maximal tumour control against functional preservation and quality of life.

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Surgical Management of Craniopharyngiomas publication trend

The graph below shows the total number of articles in surgical management of craniopharyngiomas across all publications each year (not limited to Nature Index journals).

Technical terms

Craniopharyngioma: benign epithelial tumour of the sellar region arising from embryonic remnants of Rathke’s pouch.

Gross total resection (GTR): surgical removal of all visible tumour tissue aiming for no residual mass.

Sub-total resection (STR): deliberate partial removal of tumour to preserve critical structures, often followed by radiotherapy.

Hypothalamic-sparing surgery: operative strategy designed to minimise damage to hypothalamic nuclei while resecting tumour.

Radiotherapy: targeted ionising radiation delivered post-operatively to control residual or recurrent tumour.

BRAFV600E mutation: activating substitution in the BRAF gene signalling pathway often found in papillary craniopharyngiomas, targetable with specific inhibitors.

References

1. Craniopharyngioma. Orphanet Journal of Rare Diseases (2007).
2. Recurrent papillary craniopharyngioma with BRAFV600E mutation treated with neoadjuvant-targeted therapy. Acta Neurochirurgica (2017).