Long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas

Objective To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas. Methods Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration, followed by fractionated stereotactic radiotherapy (FSRT). The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents. The collimator of FSRT ranged from 2.5 cm to 3.0 cm, and the target volume 1.1-43.8 cm3, dose per fraction 1.8 Gy, total dose 50.4 Gy. Results The median follow-up period was 72.9 months. Tumor control was achieved in 8 of 9 patients. Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months, 1 year, and 2 years. One recurrent case showed multilobulated cysts, and a second surgery was required 1 year after the treatment. Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure. No new visual disturbances, endocrinopathy, or hypothalamic dysfunction was observed during follow up. Conclusions Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time, improve the clinical symptoms and avoid endocrine diseases. Key words: Craniopharyngioma; Neuroendoscopy; Stereotaxic techniques; Radiotherapy