Stereotactic radiosurgery for pediatric craniopharyngiomas: a multicenter retrospective study.
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PURPOSE: The role of stereotactic radiosurgery in the management of pediatric craniopharyngiomas remains incompletely defined, particularly with respect to long-term disease control and late treatment-related morbidity. This multicenter study evaluates long-term tumor control and functional outcomes following Gamma Knife radiosurgery (GKRS) in pediatric patients with craniopharyngiomas. METHODS: We retrospectively analyzed 33 pediatric patients (< 18 years) treated with GKRS for residual or recurrent craniopharyngiomas at two independent and experienced neurosurgery centers. Radiological tumor control, recurrence-free survival, visual and endocrinological outcomes were assessed longitudinally. Kaplan-Meier and Cox regression were used to identify factors affecting outcomes. RESULTS: The mean age at GKRS was 11.8 years, and the mean tumor volume was 2.3 cm³. The median follow-up was 122.8 months (IQR 79.4-204.3 months). Recurrence-free survival rates at 1, 3, 5, and 10 years were 84.8%, 78.6%, 67.7%, and 48.6%, respectively. Among patients with tumor progression, 66.7% experienced out-of-field recurrence, whereas in-field failures were less common and occurred after a significantly longer interval (63.9 ± 7.7 vs. 19.6 ± 18.3 months; p < 0.01). Visual function remained stable or improved in 97% of patients. One patient experienced visual deterioration (3.0%) related to tumor progression. New-onset endocrinological deficits were uncommon and occurred in patients with pre-existing hypopituitarism (6/27, 22.2% vs. 0/6, 0%, p = 0.003). CONCLUSION: GKRS provides durable control of treated tumor volumes with minimal long-term visual and endocrinological morbidity in selected pediatric patients with craniopharyngiomas. Late disease progression predominantly occurred outside the treated volume, while in-field recurrences were less frequent and characterized by a longer latency.