eMedicine Specialties > Neurology > Neuro-oncology

Craniopharyngioma: Follow-up

Author: George C Bobustuc, MD, Consulting Staff, Department of Neuro-Oncology, MD Anderson Cancer Center Orlando
Coauthor(s): Morris D Groves, MD, Assistant Professor, Department of Neuro-Oncology, MD Anderson Cancer Center, University of Texas; Gregory N Fuller, MD, PhD, Professor of Pathology, Chief, Section of Neuropathology, Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center; Franco DeMonte, MD, FRCSC, FACS, Professor of Neurosurgery, Mary Beth Pawelek Chair in Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston Texas
Contributor Information and Disclosures

Updated: Sep 4, 2009

Follow-up

Further Outpatient Care

  • Postsurgical follow-up should be planned in 1-2 weeks for all patients.
  • Patients with subtotal resections and candidates for external beam radiation therapy should start radiation within 3 weeks of surgery. Patients with either complete resections or completed radiation should be seen every 3 months for the first postsurgical year, every 6 months for the second and third years, and yearly thereafter.
  • Each follow-up visit should include (1) a brain MRI that should be used for comparison with previous films and (2) correlation of the MRI with the clinical examination and neurocognitive testing results. As a rule, consider neurocognitive testing for (1) presurgery and postsurgery patients or (2) patients who underwent subtotal resection followed by radiation. All patients should have neurocognitive testing whenever declining performance (eg, school, work) is a concern or clinical examination reveals worsening neurocognitive deficits (eg, problem solving, language, memory, apraxia).
  • In some patients, deficits encountered are related to radiation injury. These could be sorted out easily by the specific MRI findings and neurocognitive testing results. Subsequently, specific treatments can be employed. Close monitoring of endocrine symptoms, accompanied by confirmatory laboratory tests, is recommended for all patients. Most patients require several adjustments of their supplemental hormonal therapy during their postsurgical/postradiation phase and even years later. Prior radiotherapy treatment was reported to not compromise the beneficial effects of GH replacement therapy.
  • Aggressive preventive management of long-term multisystem morbidities is key for long-term survival. A multiteam comprehensive approach is strongly recommended.
    • Panhypopituitarism was reported to be present in almost 90% of patients followed up for more than 10 years. Endocrinology long-term follow-up and monitoring is strongly recommended.
    • At 10 years, other highly prevalent morbidities were neurological (49%), psychosocial (47%), and cardiovascular (22%). Female sex is reported as an independent predictor of increased cardiovascular, neurological, and psychosocial morbidity. Long-term follow-up should include appropriate endocrine replacement25 (to include estrogen in premenopausal women) and aggressive control of cardiovascular risk factors (blood pressure, weight, lipids, and glucose).
  • Immunohistochemical studies and case reports caution on the possibly higher incidence of recurrence in patients receiving growth hormone and/or sex hormone replacement, as some craniopharyngiomas express IGF-1R, ER, and PRs. Despite reported sporadic expression of IGF-1R in 2 large retrospective reviews (including children and adults) where treatment duration mean was 6 years and mean follow up was approximately 10 years, no evidence was found to suggest increased recurrence rates in patients who received growth hormone (GH) supplementation.10,11 Close imaging follow-up (every 4-6 wk) and clinical monitoring would be indicated if sex hormone and/or growth hormone replacement is pursued.

Miscellaneous

Medicolegal Pitfalls

  • No consensus of opinion exists concerning the appropriate management of craniopharyngiomas. No guidelines have yet been established by the American Academy of Neurology Neuro-oncology section.
  • Most of the accepted management strategies are from retrospective reviews; no prospective randomized clinical trials have been conducted to compare the various therapeutic modalities.
  • To date, no standard-of-care issues have reached the appeals-court level to provide case law on which to base future treatment decisions.
  • The usual precautions regarding treatment of elevated intracranial pressure and surveillance for potentially life-threatening endocrinopathies should be exercised when treating patients with craniopharyngioma.
 


More on Craniopharyngioma

Overview: Craniopharyngioma
Differential Diagnoses & Workup: Craniopharyngioma
Treatment & Medication: Craniopharyngioma
Follow-up: Craniopharyngioma
Multimedia: Craniopharyngioma
References
Further Reading
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Keywords

adamantinoma, craniopharyngeal duct tumor, Rathke pouch tumor, craniopharyngioma, cystic tumor, Rathke cleft, epithelial-squamous calcified cystic tumor

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Contributor Information and Disclosures

Author

George C Bobustuc, MD, Consulting Staff, Department of Neuro-Oncology, MD Anderson Cancer Center Orlando
George C Bobustuc, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Society for Neuro-Oncology, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Morris D Groves, MD, Assistant Professor, Department of Neuro-Oncology, MD Anderson Cancer Center, University of Texas
Morris D Groves, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Gregory N Fuller, MD, PhD, Professor of Pathology, Chief, Section of Neuropathology, Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center
Gregory N Fuller, MD, PhD is a member of the following medical societies: American Association of Neuropathologists, College of American Pathologists, International Academy of Pathology, Society for Neuro-Oncology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Franco DeMonte, MD, FRCSC, FACS, Professor of Neurosurgery, Mary Beth Pawelek Chair in Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston Texas
Franco DeMonte, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Amy A Pruitt, MD, Associate Professor of Neurology, University of Pennsylvania; Attending Neurologist, Hospital of the University of Pennsylvania
Amy A Pruitt, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

 
 
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