Craniopharyngioma: treatment in the CT and MR imaging era.

PURPOSE To determine optimal treatment in patients with craniopharyngiomas. MATERIALS AND METHODS In 1977-1990, 49 patients (age range, 3-67 years; median age, 35 years; 25 female, 24 male) with craniopharyngiomas were examined. Follow-up was 5-17 years (median, 8 years). Fifteen patients were aged younger than 18 years. RESULTS All patients underwent surgical resection. Complete resection was achieved in 19. Seven patients underwent additional surgery for recurrent disease. Rate of mortality due to surgical complications was 10% (n = 5). Eight patients had marked perioperative or long-term morbidity. Twenty-five patients judged to have undergone subtotal resection underwent postoperative radiation therapy (RT). RT doses were 4,600-6,287 cGy administered in fractions of 180-200-cGy/d. Actuarial 5-year progression-free survival in patients who underwent complete resection was 63% (12 of 19 patients) versus 96% (24 of 25 patients) in patients who underwent subtotal resection followed by RT (P = .04). No RT dose response was observed. Patient functional status has not been substantially affected by adjuvant RT. CONCLUSION RT achieves excellent tumor control after subtotal resection of craniopharyngiomas.