The Role of Leksell Radiosurgery in the Management of Craniopharyngiomas.

Abstract

Management of craniopharyngiomas remains challenging due to the tumor's often intimate relationship with the optic apparatus, the hypothalamus, and the pituitary gland. Often multimodal management is needed to achieve the best treatment outcome: tumor control coupled with endocrine, visual, and neurocognitive preservation. Many surgeons favor initial subtotal resection followed by adjunctive therapy to improve quality of life in a tumor with potentially long-term survival even if coupled with a need for periodic new interventions. During the patient's subsequent follow-up, solid or cystic tumor recurrence or progression often require additional management options. Leksell stereotactic radiosurgery (SRS) is a valuable adjuvant strategy that enhances long-term outcomes in patients with residual or recurrent craniopharyngiomas. Tumor control rates of 70-90% have been reported using 11- to 13-Gy tumor margin doses delivered using the Gamma Knife. Smaller tumors are associated with better radiosurgery outcomes. SRS is an effective management for residual or recurrent solid craniopharyngiomas with a favorable benefit-to-risk profile.