NE09 Craniopharyngiomas, clinical and surgical outcomes: results of a single-center retrospective study

Abstract

Craniopharyngioma is a rare tumor associated with endocrine, metabolic, and cognitive morbidity due to its close relationship with critical structures, particularly the hypothalamus. This retrospective single-center study evaluated 68 patients treated between 2003 and 2025 to assess the impact of surgical approach, tumor topography, and intraoperative findings, including hypothalamic and pituitary stalk involvement, on functional, oncological, and survival outcomes. The cohort included 22 papillary and 46 adamantinomatous craniopharyngiomas. Preoperatively, hypopituitarism, diabetes insipidus (DI), obesity, and cognitive deficits were present in 31.8%, 12.1%, 24.2%, and 39.4% of patients, respectively. The endoscopic endonasal transsphenoidal approach (EEA) was the most frequently used surgical technique, and gross total resection (GTR) was achieved in 47% of cases. Residual tumor was observed in 53% of patients and was significantly associated with hypothalamic infiltration, pituitary stalk resection, and surgical approach. Papillary histology was the only independent predictor of a lower risk of residual disease. Surgical complications were uncommon and mainly consisted of hydrocephalus. Postoperatively, endocrine and metabolic morbidity increased, with hypopituitarism affecting 79.6% of patients, permanent DI 54.7%, and obesity 42.2%. During a mean follow-up of 62 months, recurrence or progression occurred in 40% of cases. Residual tumor, surgical approach, and tumor location were significant predictors of recurrence/progression. Mortality occurred in 10.8% of patients and was strongly associated with hypothalamic infiltration, postoperative cognitive deficits, and non-EEA approaches. Conclusions: Tumor–hypothalamus relationship emerged as the strongest determinant of surgical radicality, postoperative morbidity, and long-term survival, while EEA provided superior resection rates and lower complication rates.