Safety and Efficacy of Repeat Surgery for Recurrent Craniopharyngiomas: A RAPID Consortium Collaboration

BACKGROUND AND OBJECTIVES: Craniopharyngiomas (CPs) recur in 20% to 50% of cases after initial management. To date, there are no large multi-institutional series investigating outcomes in patients receiving surgery for recurrent CP. Here, we leverage the Registry of Adenomas of the Pituitary and Related Disorders to analyze outcomes after surgical treatment of recurrent CP. METHODS: Demographic, clinical, radiographic, surgical, and outcome variables were analyzed for 483 patients receiving surgery for primary or recurrent CP across 16 US-based academic skull-base centers comprising the Registry of Adenomas of the Pituitary and Related Disorders consortium from 2000 to 2024. RESULTS: Among the 483 patients, 360 (74.5%) had primary CP and 123 (25.5%) had recurrent CP. The recurrent cohort was younger at initial diagnosis ( P adj < .01) and recurrence ( P adj = .02). Adamantinomatous CPs were more common in the recurrent cohort but not significantly so, and 33.3% of cases had prior radiation therapy. Recurrent cases had more frequent preoperative endocrine dysfunction and hormone replacement ( P adj < .01). Patients with recurrent CP had less frequent suprasellar tumor extension ( P adj = .04) and more frequent preinfundibular/transinfundibular over retroinfundibular localization ( P adj = .02). There were no differences in operative approach; endoscopic endonasal surgery was the most common, and procedures achieved similar distributions of gross and subtotal resection in both cohorts ( P adj = .30) with similar low frequencies of unplanned reoperation and surgical complications. New postoperative arginine vasopressin deficiency (in patients without preoperative arginine vasopressin deficiency) was more common in the primary cohort ( P adj = .04), but long-term follow-up demonstrated similar frequencies of endocrine dysfunction in both cohorts and comparably low rates (<25%) of future recurrence within an average follow-up period of 1.57 years ( P adj = .17). CONCLUSION: This study provides the largest comparative evaluation of patients undergoing surgery for recurrent vs primary CP. Despite prior treatment, patients with recurrent CP achieved comparable resection outcomes with similar rates of neuroendocrine dysfunction. These findings indicate surgical resection remains a safe and efficacious option for recurrent CP, especially as emerging targeted therapies become available.