2026 Poster Presentations
P276: MANAGEMENT OF ADULT RECURRENT CRANIOPHARYNGIOMAS: A SINGLE-INSTITUTION COHORT STUDY
Sharath Kumar Anand, MD; Brock Gjesdal; Robert Dambrino, MD; Anthony Tang; Akanksha Aggarwal, MD; Katherine Mastandrea; Divya Sistla, MD; Pouneh Fazeli, MD; Garrett Choby, MD; Eric Wang, MD; Carl Snyderman, MD, MBA; Georgios Zenonos, MD; Paul Gardner, MD; UPMC
Introduction: Achieving gross total resection (GTR) in recurrent craniopharyngiomas is challenging due to scarring, altered anatomy, and effects of prior treatments. Understanding which factors are associated with successful GTR could better inform surgical planning and patient counseling. We performed a descriptive analysis to identify trends in GTR achievement among adults undergoing surgery for recurrent craniopharyngioma.
Methods: This is a single-institution retrospective cohort study of consecutive adult patients who underwent endoscopic endonasal approach for resection for recurrent craniopharyngioma between 2008 to 2024. GTR was defined based on surgeon intraoperative impression and complete tumor removal on postoperative imaging. GTR rates were stratified by potential predictive factors including prior treatments (stereotactic radiosurgery [SRS], prior surgeries, surgical approach), tumor characteristics (volume, location), patient demographics, and preoperative conditions. Median (IQR) age and tumor volume were compared by GTR status. Effect of residual tumor was assessed; we analyzed recurrence rates by relative risk and absolute risk difference (95% confidence intervals), and compared time to recurrence between patients with and without noted residual using Wilcoxon rank-sum test.
Results: We identified 28 cases of recurrent craniopharyngioma in 24 unique adult patients. GTR was achieved in 12/28 (42.9%) cases, with near-total resection (NTR) accounting for 16/28 (57.1%) (Table 1). Differences in preoperative characteristics between those patients who had a GTR and did not have a GTR are summarized in Table 2; there were no statistically significant correlations. Other factors including prior SRS, hypothalamic invasion, and optic tract involvement similarly showed insignificant differences in GTR rates. Patients with NTR showed nearly double the rate of recurrence (10/16 (62.5%) vs. 4/12 (33.3%) GTR, p=0.252). While sample size limited power, clinical relevance is notable with a relative risk of recurrence of 1.88 (95% CI: 0.77-4.55), and absolute risk difference of 29.2% (95% CI: -6.5-64.9%). Time to recurrence was the same for each group (28 months no residual, 22-44 compared (29 months without residual, 24-35; p=0.887, Wilcoxon rank-sum).
Conclusions: Although we identified no significant predictive factors for GTR for recurrent craniopharyngiomas, multiple meaningful trends were still present, most notably the effect of NTR doubling the rate of recurrence in this small cohort. These findings highlight the importance of GTR in adult patients with recurrent craniopharyngioma. While there may be certain factors that potentiate GTR larger case series are required to delineate these factors.
