Craniopharyngiomas in children: the pendulum moves again for an aggressive surgery-late complications and considerations with a recent series of 26 patients treated in Lyon.
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BACKGROUND: Craniopharyngioma (CP) surgery in children leads to high rate of recurrence, and morbid complications. Transcranial approach is the most frequently proposed surgical technique, but transsphenoidal endoscopic approach is also used. Pre- and post-operative complications of the tumor are well known, but early multidisciplinary management could improve the long-term outcome of these patients. The aim of this study was to analyse the risk factors for pre-and post-operative long-term complications in a series of patients operated with an aggressive removal for CP. METHODS: A retrospective study of 26 children diagnosed with CP was carried out. The surgical total removal was possible in 88% of cases after the revision of the post-operative MRI realized in the first 48 h. RESULTS: Children with hypothalamic involvement were more likely to have endocrine deficits and to be overweight or obese pre-operatively. They also had a higher risk of early post-operative complications, and late morbidities. CONCLUSION: Children with CP and strong hypothalamic involvement, have a higher risk of pre- and post-operative complications but complete removal is associated with a high rate of cure with global good neuropsychological results. Early multidisciplinary post-operative management should be reinforced to improve the long-term outcome but surgery with total removal can insure definitive acceptable clinical results.