Management of Craniopharyngioma in Childhood

Abstract

HE purpose of this paper is to present briefly a summary of recent clinical experience at the Children's Hospital Medical Center in Boston with radical surgery for craniopharyngioma and then to discuss in more detail the complex fluid and steroid problems involved in management during the early postoperative period. In addition, mention will be made of the more significant neuroendocrine studies involved in conscientious long-term follow-up of these patients. Material In all, 74 patients with surgically verified craniopharyngiomas have been treated by this neurosurgical clinic. Of these, 10 were treated prior to 1950 when adrenocorticotropin (ACTH) and the glucocorticoid, cortisone, became available for clinical use. In none of these patients was the tumor completely and successfully removed, and all subsequently died because of the tumor or attempts to irradiate or remove it. These patients will not be referred to further. An additional seven patients were adults varying in age from 35 to 65 years when operated on. These constitute a separate group with different surgical indications, usually much simpler operative problems, and special postoperative plans for endocrine management. They, also, will be excluded from further discussion. This leaves a group of 57 children treated