Treatment of recurrent craniopharyngiomas.

One of the most common complications of craniopharyngioma treatment is recurrence. The outcomes of treatment for recurrent tumors with different modalities were evaluated. Of the 61 patients treated initially, 24 had recurrence during follow-up period (1-29 years, mean 11 years). Twenty-two patients underwent a total of 35 additional operations for recurrence. With reoperation, total surgical removal was achieved for four occasions (Group a), subtotal resection was achieved with 31 surgical procedures. Nineteen procedures (Group b) were done without radiotherapy and seven were followed by radiotherapy (Group c). Seven patients were treated with radiosurgery (Group d) with or without surgical resection. The surgical mortality rate for Group a was 50% which was higher than for initial operation, while for Group b 10.5% and none for Groups c and d. Good functional status was maintained at follow-up in 50% of survived patients for Group a, 14% for Group b, 57% for Group c and 86% for Group d. The 5-year recurrence free survival rate was 50% for Group a, 16% for Group b, 80% for Group c, and 83.3% for Group d. The rate of recurrence free survival for Group b was significantly lower than Group c (P = 0.004) and Group d (P = 0.001). The recurrence free survival rates were higher for Groups c and d than for Group b. The mortality and morbidity higher in the Group a. Radiotherapy and radiosurgery are useful adjuncts for the treatment of recurrence, resulting in a high recurrent-free survival rate with better functional outcome.