Recurrence rates after neuroendoscopic fenestration and Gamma Knife surgery in comparison with subtotal resection and Gamma Knife surgery for the treatment of cystic craniopharyngiomas.

Abstract:  Object The object of this study was to compare the recurrence rates of cystic craniopharyngiomas after neuroendoscopic cyst fenestration combined with Gamma Knife surgery (GKS) and after subtotal resection (STR) combined with GKS. Methods The records of 27 patients (age range 3-66 years) with cystic craniopharyngiomas that were treated surgically or neuroendoscopically before GKS between January 2000 and December 2007 were reviewed to compare recurrence rates. The patients were divided into 2 groups: Group 1 (13 patients) received the neuroendoscopic procedure before GKS, and Group 2 (14 patients) received an STR followed by GKS. Tumor volumes, radiation doses, visual field defects, endocrine levels, and recurrences were compared between the 2 groups. Patients with solid tumors and those who underwent complete resection were excluded from the study. Results The recurrence rate for Group 1 was higher than that of Group 2 (p = 0.046). The radiation dose near the optic chiasm was higher in Group 1 (p = 0.021) than in Group 2. However, endocrine function was better preserved in Group 1 than in Group 2. Conclusions This investigation confirms that STR followed by GKS results in a lower recurrence rate than neuroendoscopy and GKS. Neuroendoscopy and GKS, however, results in a better preservation of endocrine function. These results suggest that a generalized multimodal approach including endoscopic fenestration in addition to GKS is hindered by higher recurrence rates.