A retrospective analysis of the outcome of 50 cases of craniopharyngioma treated in infancy by radical or subtotal surgical excision and irradiation is reported from the Services of Neurosurgery and Endocrinology, Hopital des Enfants Malades, 149, reu de Sevres, 75743 Paris Cedex 15, France. The authors concluded that 1) radical excision is the treatment of choice; 2) if radical excision is not possible, surgery should be followed by irradiation to lower risk of recurrence; and 3) radiotherapy should be delayed as long as possible because of hazards to growing brain and used only when tumor recurrence has been demonstrated. After radical excision, the rate of recurrence was lowest, with a 10 year recurrence-free survival rate of 88%. After subtotal removal, the recurrence-free survival rate, 10 yrs post-op, was 37%; this rate was significantly higher (72%) when subtotal removal was followed by irradiation, but deafness and severe neuropsychological and intellectual sequelae were frequent complications of irradiation. Post-operative mortality was low in pre-chiasmatic cases and high in retro-chiasmatic tumors. Surgical statistics may improve with newer techniques. [1]

COMMENT: The neuropsychological deficits ascribed to irradiation in this report may be explained in part by the location of the tumor. Cognitive defects have been correlated with frontal lobe abnormalities seen on MRI in 4 patients with craniopharyngioma. [2]