Surgery
than those of the general population. This difference is thought to be largely due to cardiovascular mortality.41
Manifestations of
hypothalamic dysfunction may significantly affect a patient’s psychosocial functioning. One study found that 84% of adults and 74% of children treated with surgery were able to live independent lives with social integration and normal professional occupation at a mean follow-up of seven years.41
can affect many facets of a patient’s biology, management should be multidisciplinary.
Conclusions
Conclusive treatment for craniopharyngiomas remains a matter of debate. Although GTR yields lower recurrence rates and longer survival, there is a trade-off between efficacy and morbidity. With higher resection rates comes the contrecoup of damaging critical neural and vascular structures in the vicinity of the craniopharyngioma. When GTR is not an option, STR combined with radiotherapy becomes the therapeutic option of choice.
Whether considering GTR or STR, there are many possible surgical approaches to consider. Most importantly, the treatment of craniopharyngiomas is complicated both surgically and medically, necessitating a multidisciplinary approach involving neurosurgery, neurology, endocrinology, ophthalmology and neuropsychology. n
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Ricardo J Komotar is Chief Resident in Neurosurgery in the Department of Neurological Surgery at the Neurological Institute of New York at Columbia University Medical Center. He plans to complete a neuro-oncologic fellowship at Memorial Sloan Kettering Cancer Center with an interest in academic neuro- oncology, skull base surgery and neuroendoscopic techniques. He obtained his undergraduate degree from Duke University and attended the Johns Hopkins University School of Medicine.
Christopher P Kellner is a Junior Resident in the Department of Neurological Surgery at the Neurological Institute of New York at Columbia University Medical Center. His research interests include cerebrovascular disease and skull base surgery techniques. He attended Harvard College as an undergraduate, followed by Columbia College of Physicians and Surgeons for medical school.
Jeffrey N Bruce is a Professor of Neurological Surgery in the Department of Neurological Surgery and Co-Director of the Brain Tumor Center and Director of Skull Base Surgery at the Neurological Institute of New York at Columbia University Medical Center. He specialises in the surgical treatment of gliomas, meningiomas, pituitary tumours, skull base tumours, craniopharyngiomas and pineal tumours. Professor Bruce also manages a brain tumour laboratory at Columbia.
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