Therapeutic strategy for craniopharyngiomas based on recent reports

Abstract

Craniopharyngiomas have been described as the most challenging intracranial tumors because they originate from the remnants of the Rathke’s pouch and extend in various directions from the sella turcia, even reaching the third ventricle. Moreover, there are important anatomical structures such as the hypothalamus, third ventricle, optic apparatus, carotid arteries, and surrounding perforator vessels surround the tumor. The optimal treatment for craniopharyngiomas has not yet been established. However, a complete resection during the first surgical attempt is described as the most effective treatment from an oncological perspective, as treatment of a recurrent lesion may be more complicated. The surgical priority is to maximize resection while preserving the patient’s long‒term functional outcome and quality of life. A balance between tumor removal and damage to nearby critical neurovascular structures should be found. Radiotherapy is also a good treatment option for recurrent or residual tumors. However, obtaining complete tumor control with radiation therapy is not straightforward, and radiation has been reported to cause injury to the surrounding organs. Currently, several advanced techniques such as an extended transsphenoidal approach, 3D conformal radiotherapy, or monoclonal immunotherapy may be performed. The aim of this report was to summarize the main principles of craniopharyngiomas treatment strategies through a review of the existing literature.