Overview of surgical approaches and adjuvant therapy for treatment of craniopharyngiomas

Craniopharyngiomas are brain tumors that occur in the sellar and suprasellar regions and are seen in both adult and pediatric patients. They are benign tumors, but their location and relation with critical neurovascular structures, including optic chiasm, hypothalamus, and pituitary gland, make their treatment challenging. Patients often present with headaches, neurologic symptoms, and pituitary dysfunction. Surgical resection is the first line of treatment. Historically, surgeries for these tumors have involved open cranial approaches. However, endoscopic endonasal approaches have become increasingly more popular in recent years. They provide similar to slightly increased rates of gross total resection and increased rates of visual preservation or improvement. Unfortunately, both options still carry significant risk of postoperative endocrinopathies for these patients. Given the involvement of these tumors with surrounding structures, especially the hypothalamus, current protocols recommend maximal safe resection followed by adjuvant therapies. Radiation therapy for tumor recurrences is often used. Intracystic therapies, including brachytherapy, bleomycin, and interferon alpha therapy, have all been tried with varying success. Last, advances in the understanding of molecular underpinnings of these tumors have led to promising new systemic therapies for certain subset of these tumors.