Craniopharyngioma in Children: Surgical Considerations

The management of craniopharyngiomas, especially in childhood, remains a controversial and challenging subject (Carmel et al. 1982; Fischer et al. 1985; Katz 1975; Yasargil et al. 1990). This histologically benign tumor is of maldevelopmental origin and develops in a particular intracranial location, close to the optic pathways, the hypothalamus, the hypophysis, and the internal carotid arteries and their main branches. Its spontaneous evolution is unforeseeable. The location and firm attachment to important surrounding anatomical structures make its surgical extirpation possible, but difficult and risky. Other therapeutic modalities have been proposed, such as conventional or interstitial irradiation or even chemotherapy. The choice of one or another treatment depends on the patient’s age, the aspects of the lesion, the skyll of the surgeon, and, moreover, the personal opinion and the firm belief of the physician. Consequently, it is not so easy to establish a definitive protocol for the management of craniopharyngioma. We have tried in this presentation to present our personal therapeutic approach to this tumor, considering exclusively the pediatric age.