Functional Outcomes of Pediatric Craniopharyngiomas in Relation to Treatment Approach

OBJECTIVE To evaluate functional outcomes following treatment of pediatric craniopharyngiomas, stratified by treatment approach and extent of resection. METHODS We retrospectively reviewed patients under 21 years treated for craniopharyngioma at Children’s National Hospital between 2002–2022. Inclusion criteria were Ommaya reservoir placement or surgical resection with follow-up data. Standard statistical analyses were used. RESULTS Forty patients underwent 59 procedures. Mean age at presentation was 8.6 years, with average follow-up of 65.5 months. Most (72.5%) underwent a single procedure. Tumors were primarily intra-suprasellar (85%). Initial procedures included open craniotomy (77.5%), Ommaya reservoir placement (15%), and endoscopic endonasal resection (7.5%). Six patients had prior surgery elsewhere. GTR was intended in 23 cases and achieved in 16 (69.5%). Postoperative radiation was given to 45%, and 27.5% underwent neuropsychological evaluation. No complications occurred in 80.5% of procedures. Endocrine outcomes differed significantly by surgical approach: adrenal insufficiency (p<0.001), hypothyroidism (p=0.01), and diabetes insipidus (p<0.001) were more frequent after open craniotomy. Similarly, extent of resection correlated with adrenal insufficiency (p<0.001), hypothyroidism (p<0.001), growth hormone deficiency (p=0.03), and diabetes insipidus (p<0.001). Visual and neurologic outcomes did not differ significantly by surgical approach or resection extent. CONCLUSIONS Treatment-related endocrine morbidity is significantly influenced by surgical approach and extent of resection. However, most patients maintain stable visual and neurologic function postoperatively. These findings highlight the need for treatment strategies that minimize long-term functional impairment while maintaining disease control.