Factors predictive of recurrence and functional outcome were determined in a retrospective clinicopathological analysis of 56 patients (26 children and 30 adults) operated on for craniopharyngioma since 1981 at New York University Medical Center. Children underwent gross total resection (GTR) of tumor more frequently than adults (77% cf 27%). Tumors were almost all adamantinomatous in children, whereas in adults, two thirds were adamantinomatous and one third were squamous papillary. Brain invasion was most frequent with the adamantinomatous craniopharyngiomas; invasion had occurred in 46% of the children compared with 17% of adults. Subtotal resection was associated with a higher rate of recurrence compared with total resection. Brain invasion had no effect on recurrence rate in totally resected cases. Functional, visual, and endocrine outcomes were not sacrificed by total resection of tumor. 
COMMENT. The single most important factor predictive of craniopharyngioma recurrence is the extent of surgical resection. Total compared to subtotal resection has a significantly lower recurrence rate without affecting functional outcome. Brain invasion does not predict higher recurrence provided the tumor is totally resected.
Estogen Receptor Gene Expression. Craniopharyngiomas are histologically benign neoplasms of the sellar region that frequently show local invasion of brain tissue. In a collaborative study at the University of Toronto, Canada, the Mayo Clinic, and the University of Virginia, Charlottesville, 23 surgically removed craniopharyngiomas uniformally expressed the estrogen receptor gene. A possible hormonal component to the genesis and progression of craniopharyngiomas and investigation of hormonal therapy are suggested.