P298 - ECE_2816 - Craniopharyngiomas, Clinical And Surgical Outcomes: Results Of A Single-Center Retrospective Study

Abstract

Craniopharyngioma is a rare tumor of the sellar region that causes significant clinical effects due to its proximity to critical structures such as the hypothalamus. Data of 68 patients, followed at our center between 2003 and 2025, were retrospectively reviewed. Endocrine, cognitive, and metabolic outcomes were assessed pre- and postoperatively. The extent of resection and tumor location were evaluated by a dedicated neuroradiologist. Univariable and multivariable logistic regression identified predictors of residual tumor and recurrence/progression. Survival was assessed via Kaplan–Meier analysis. We included 22 papillary craniopharyngiomas (CPs) (13 females; 9 males) with a mean age of 52.3 years (18-82) and 46 adamantinomatous craniopharyngiomas (CAs) (18 females; 28 males) with a mean age of 46.3 years (5-74). Preoperatively, hypopituitarism, diabetes insipidus (DI), obesity, and cognitive deficits were present in 31.8%, 12.1%, 24.2% and 39.4% of patients, respectively. Surgery mostly required a transsphenoidal endoscopic approach (EEA) (45.5% CPs; 50% CAs). Gross total resection (GTR) was achieved in 47% of cases. Residual tumor occurred in 53% of patients and was strongly associated with hypothalamic infiltration (71.9% vs 33.3%, P = .007), pituitary stalk resection (92.9% vs 42.2%, P = .004), and surgical approach (P = .039), with EEA showing the strongest association with GTR. Papillary histotype was the only independent predictor of lower residual tumor risk (OR 0.205, P = .019). Surgical complications were rare, mainly hydrocephalus (CPs 2; CAs 3). Postoperatively, hypopituitarism affected 79.6%, permanent DI 54.7%, and obesity 42.2% of patients; cognitive deficits were present in 10.6%. During a mean follow-up of 62 months, recurrence/progression occurred in 40% of patients. Residual tumor (P = .026), surgical approach (P = .013), and tumor location (P = .014) significantly predicted progression/recurrence. Recurrence after GTR occurred earlier (mean 6.5 months), whereas progression of residuals occurred later (16.5 months) but required reoperation more frequently (72%). No variable independently predicted recurrence/progression. Seven patients (10.8%) died during follow-up, including three perioperative deaths. Mortality was strongly associated with hypothalamic infiltration (P = .018), postoperative cognitive deficits (P = .003), complications (P < .001), and surgical approach (P = .002). Survival analysis showed significantly reduced survival with non-total resection (P < .001), pituitary stalk preservation (P < .001), and non-EEA approaches (P < .001). Tumor–hypothalamus relationship is the strongest determinant of surgical radicality, postoperative morbidity, and long-term survival. EEA offers superior resection rates and lower complication rates.