2026 Proffered Presentations
S035: EFFICACY AND PERIOPERATIVE MORBIDITY IN THE RESECTION OF RECURRENT CRANIOPHARYNGIOMAS: A MULTI-INSTITUTIONAL REPORT OF THE RAPID REGISTRY
Ryan Shih1; Jorge Salcedo-Sifuentes1; Maya Harary1; Marvin Bergsneider1; Kyle Wu2; Daniel Prevedello2; James J Evans, MD3; Michael R Chicoine, MD4; Albert H Kim, MD, PhD5; Julie M Silverstein, MD5; Michael Karsy, MD, PhD6; Jamie Van Gompel, MD, PhD7; Donato R Pacione8; Carter Suryadevara, MD8; Paul A Gardner, MD8; Stephanie Cheok, MD9; Nathan Zwagerman, MD9; Varun R Kshettry, MD10; Robert C Rennert, MD11; William T Couldwell, MD, PhD11; Garni Barkhoudarian, MD12; Juan C Fernandez-Miranda, MD13; Gabriel Zada, MD14; Carolina Benjamin, MD15; Michael P Catalino, MD, PhD16; Adam Mamelak, MD17; Georgios Zenonos, MD18; Ramin Morshed, MD19; Spiros Blackburn, MD20; Debraj Mukherjee, MD21; Andre Beer-Furlan, MD22; Kevin C Yuen, MD23; Ildiko Torok, MD23; Andrew S Little, MD23; Won Kim, MD1; 1UCLA Department of Neurosurgery; 2The Ohio State University; 3Jefferson University; 4University of Missouri; 5Washington University School of Medicine; 6University of Michigan; 7May Clinic; 8New York University; 9Medical College of Wisconsin; 10Cleveland Clinic Foundation; 11University of Utah; 12Pacific Neuroscience Institute; 13Stanford; 14University of Southern California; 15Miller School of Medicine, University of Miami; 16University of Virginia; 17Cedar Sinai Medical Center; 18University of PIttsburgh; 19University of California, San Francisco; 20University of Texas Health; 21Johns Hopkins University; 22Moffitt Cancer Center; 23Barrow Neurological Institute
Background and Objectives: Craniopharyngiomas are benign parasellar tumors that recur in 20-50% of cases following initial surgical management. To date, there are no large multi-institutional series investigating outcomes in patients undergoing surgery for recurrent craniopharyngiomas. We utilized the multi-institutional Registry of Adenomas of the Pituitary and Related Disorders (RAPID) to analyze outcomes following the surgical treatment of these commonly recurrent tumors.
Methods: Clinical, radiographic, surgical, and postoperative variables were analyzed for 483 patients receiving surgery between 2000-2024 for primary or recurrent craniopharyngiomas at US-based academic medical centers comprising the RAPID consortium.
Results: 360 (74.5%) patients had primary craniopharyngiomas and 123 (25.5%) had recurrent tumors. Patients in the recurrent cohort were younger at initial diagnosis (48.6 vs 37.2; Padj<0.001) and time of surgery (50.4 vs 41.4; Padj=0.02). The majority of recurrent tumors were the adamantinomatous subtype (86%), similar to the primary cohort. Recurrent patients had an increased incidence of preoperative hypopituitarism and replacement therapy (Padj<0.001) (Table 1). Recurrent craniopharyngiomas had less frequent suprasellar extension (Padj=0.04) and more frequent pre/transinfundibular over retroinfundibular localization (Padj=0.02) (Table 1). There was no significant difference in surgical technique used or extent of resection between primary and recurrent groups (GTR 45% vs 48.6%, respectively; Padj=0.29), though prior radiation was associated with lower rates of GTR in the recurrent group (53.5% vs 40%; Padj<0.02) Rates of perioperative complications including postoperative CSF leak, visual decline, VTE, or death were similar between groups, with lower rates of new postoperative ddAVP dependent AVP-deficiency (57% vs 38.1%), adrenal insufficiency (53.5% vs 38.1%), and hypothyroidism (53.8% vs 32.5%) in the recurrent cohort (Padj<0.01).
Conclusion: This multi-institutional study provides the largest comparative evaluation to date of patients undergoing surgery for recurrent versus primary craniopharyngioma. Despite prior treatment, patients with recurrent craniopharyngiomas experienced comparable extents of resection and perioperative complications as the primary group, with fewer new postoperative endocrinopathies. Collectively, these findings suggest that surgical resection is a safe and effective form of management in patients with recurrent craniopharyngiomas.
