2026 Poster Presentations
P187: A QUARTER-CENTURY OF PEDIATRIC CRANIOPHARYNGIOMA SURGERY: INSIGHTS FROM A SINGLE CENTER IN MADRID
Pablo Garcia Feijoo, MD, FEBNS1; Haris Mehdic, MD2; Carlos Perez Lopez, MD, PhD1; Javier Saceda Gutiérrez, MD, PhD1; Jorge Zamorano Fernandez, MD1; Álvaro Zamarron Perez, MD1; Isabel Esteban, MD, PhD1; Sara Quiñones Garrido, MD1; Fernando Carceller Benito, MD, PhD1; 1Hospital Universitario La Paz; 2University of Zagreb School of Medicine
Background: Pediatric craniopharyngiomas correspond to the adamantinomatous type, and their presentation is usually dominated by visual field disturbances, intracranial hypertension, hormonal deficits, and severe symptoms. They are typically complex tumors that frequently involve some degree of hypothalamic dysfunction. This series aimed to describe surgical trends regarding approach, technique, number of interventions, and use of radiotherapy in a large pediatric cohort from a single center. We sought to provide a real-world perspective on the management and outcomes of craniopharyngiomas over the past two decades in our institution.
Methods: All pediatric patients (<18 years) operated at our institution between 1999 and 2025, with available clinical records and confirmed histopathological diagnosis of craniopharyngioma, were included. A descriptive study was conducted, analyzing epidemiological data, surgical management, and radiotherapy use.
Results: A total of 23 patients with craniopharyngioma were included, with a median age at first surgery of 6.9 years (mean 8.3 years). The mean follow-up duration was 11 years and 7 months, and the mean number of surgeries per patient was 2.3 (range, 1–8). The three main treatments were open craniotomy (67%), endoscopic approach (27%), and Ommaya reservoir placement for cyst evacuation (6%). Radiotherapy was used in 61.9% of cases, with the last six patients undergoing proton beam therapy. Notably, 71% of endoscopic endonasal approaches were performed after 2015. A ventriculoperitoneal shunt was required in 9.5%. Postoperative permanent diabetes insipidus occurred in 85% (prior to surgery in 50%) and pituitary dysfunction affecting at least one hormonal axis in 95% (similar to presurgical condition). According to Kassam’s classification, 57% were transinfundibular type, while at least 40% were infundibulo-tuberal according to Pascual’s classification. Intraventricular extension was present in 52.4%.
Conclusion: This large pediatric series adds to the current literature, highlighting trends over the last two decades. There is a clear shift toward hypothalamic preservation during surgery, often leading to subtotal resection followed by radiotherapy. A progressive increase in the use of endoscopic approaches and non-resective strategies, such as Ommaya reservoir placement, has also been observed in recent years. Increasing use of proton beam as the favorite radiotherapy modality was noticed.