Surgery of large retrochiasmatic craniopharyngiomas in children

From 1981 to 1988, 24 patients with craniopharyngiomas were operated at the Neurosurgical Clinic of the City Hospital of Hannover. Eleven patients were females and 13 males. The median age was 39 years. Ten patients were 20 years of age or younger at the time of surgery. Among these there were four patients who had large (more than 3 cm in greatest diameter), prevalently retrochiasmatic tumors. They represent 40% of the patients up to 20 years of age. Their age ranged from 8 to 17 years; they were all females. Two patients presented with increased intracranial pressure secondary to hydrocephalus, one patient with decreased vision, and one patient presented with seizures. One patient had been previously operated twice elsewhere. A preoperative shunting procedure was necessary in two patients (in one it was bilateral). All patients were preoperatively evaluated with enhanced and nonenhanced computerized tomography (CT) and with angiography. The major tumor diameter was 4 cm or more in three patients and between 3 and 4 cm in one patient. All tumors were prevalently retrochiasmatic. Three tumors extended to the level of the middle clivus. The tumor was approached subfrontally in two patients and subfrontotemporally in two patients. There was no operative mortality. No patient was neurologically worse postoperatively. All patients required hormonal replacement. Adjuvant therapy was not given. All four patients are clinically and CT recurrence free 5 and 20 months and 3 and 4 years after the surgery.