Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-analysis

The optimal therapeutic approach for adult craniopharyngioma remains controversial. Some advocate for gross total resection (GTR), while others advocate for subtotal resection followed by adjuvant radiotherapy (STR + XRT). To conduct a systematic review and meta-analysis assessing the rate of recurrence in follow-up of 3 years in adult craniopharyngioma stratified by extent of resection and presence of adjuvant radiotherapy. MEDLINE (1946 to July 1, 2016) and EMBASE (1980 to June 30, 2016) were systematically reviewed. From 1975 to 2013, 33 patients were treated with initial surgical resection for adult onset craniopharyngioma at our center. Data from 22 patients were available for inclusion as a case series in the systematic review. Eligible studies (n = 21) were identified from the literature in addition to a case series of our institutional experience. Three groups were available for analysis: GTR, STR + XRT, and STR. The rates of recurrence were 17, 27, and 45%, respectively. The risk of developing recurrence was significant for GTR versus STR (OR: 0.24, 95% CI: 0.15–0.38) and STR+XRT versus STR (OR: 0.20, 95% CI: 0.10–0.41). Risk of recurrence after GTR versus STR + XRT did not reach significance (OR: 0.63, 95% CI: 0.33–1.24, p = 0.18). This is the first and largest systematic review focusing on rate of recurrence in adult craniopharyngioma. Although rates of recurrence are favoring GTR, difference in risk of recurrence did not reach significance. This study provides guidance to clinicians and directions for future research with the need to stratify outcomes per treatment modalities.