Role of gamma knife radiosurgery in multimodality management of craniopharyngioma.

OBJECTIVE This retrospective study evaluated the efficacy and safety of the use of Gamma Knife Radiosurgery (GKS) along with other surgical procedures in the management of craniopharyngioma. METHODS Thirty-five patients (17 children and 18 adults) with craniopharyngioma were treated with GKS between May 2008 and August 2011. The age of the patients ranged from 2 to 53 years (mean 20 years). There were 26 males and 9 females. Craniopharyngiomas were solid in 7 patients, cystic in 4, and mixed in 24. Tumor size ranged from 1 to 33.3 cm(3) (mean 12 cm(3)). The prescription dose ranged from 8 to 14 Gy (mean 11.5 Gy). Maximum dose ranged from 16 to 28 Gy (mean 23 Gy). Before GKS 11 patients underwent subtotal resection of the neoplasm, 2 - neuroendocopic fenestration of the large cystic component, and 10 - stereotactic aspiration of the neoplastic cyst content. RESULTS The length of follow-up period varied from 6 to 36 months (mean 22 months). The tumor response rate and control rate were 77.1 % and 88.5 %, respectively. Clinical outcome was considered excellent in 10 cases, good in 17, fair in 4, and poor in 4. No one patient with normal pituitary function before GKS developed hypopituitarism thereafter. Deterioration of the visual function after treatment was noted in one patient. CONCLUSION After GKS tumor control can be achieved in significant proportion of patients with craniopharyngioma. Treatment-related neurological morbidity in such cases is rare. Therefore, radiosurgery may be considered useful for management of these tumors.