Neurosurg Focus. 2026 Jun 1;60(6):E4. doi: 10.3171/2026.2.FOCUS251137.
ABSTRACT
OBJECTIVE: The authors present a single-institution experience of patients with large and giant pediatric craniopharyngiomas (CPs) who underwent the extended endoscopic endonasal approach (EEA) at their institution over a 6-year period.
METHODS: Twenty-two consecutive patients ≤ 18 years of age with large (≥ 3 cm) or giant (≥ 5 cm) CPs were treated with EEA between 2016 and 2022 at Rady Children’s Health, San Diego. Clinical outcomes, rates of recurrence, and time to proton therapy were evaluated. Descriptive analyses and Fisher’s exact tests were used to compare categorical variables. A p value < 0.05 was considered statistically significant. The authors performed a literature review to compare their series to historical control outcomes.
RESULTS: Twenty-two patients presenting with large or giant adamantinomatous CP met inclusion criteria (10 males; mean age 9.3 years, range 3.4-17.8 years). Tumor size (mean 4.7 ± 1 cm) was classified as large (≥ 3 cm, n = 14) or giant (≥ 5 cm, n = 8). Twenty (91%) patients achieved gross-total resection, including 7 of 8 (88%) giant tumors and 13 of 14 (93%) large tumors. Of 12 (54%) patients who presented with visual impairment, 7 (58%) improved postoperatively, 4 (33%) remained unchanged, and 1 (8%) worsened postoperatively. Preoperatively, 21 (95%) had a normal motor examination and 20 (91%) had no cranial nerve deficit, while postoperatively, 1 patient developed a new motor deficit and 1 patient developed a new cranial nerve deficit. All patients included had some degree of neuroendocrine compromise postoperatively. Recurrence was observed in 4 of 8 (50%) giant tumors and 5 of 14 (36%) large tumors, with an overall recurrence rate of 41%. Six (27%) patients received proton therapy with a mean delay of 25.7 months (SD 12.4 months). There were no significant differences in clinical features or outcomes between large and giant tumors.
CONCLUSIONS: Endonasal resection of large and giant pediatric CPs is feasible in an experienced multidisciplinary center and can result in avoidance or significant delay of postoperative proton radiation therapy, minimizing the risk of associated neurological and endocrinological late effects. Resection rates and complication profiles are similar to those in the existing peer-reviewed literature.
PMID:42224719 | DOI:10.3171/2026.2.FOCUS251137
