OBJECTIVE: The management of children with craniopharyngioma has evolved over 
time, with a trend toward less invasive neurosurgical approaches as surgeons 
have sought to balance oncological control and treatment-related morbidity. To 
this end, the aim of this study was to evaluate the safety and effectiveness of 
the current management of children with craniopharyngioma compared to the 
previous management methods used at the authors' treatment center.
METHODS: A prospectively maintained database was searched over a 14-year period 
between January 1, 2005, and December 31, 2018, to identify all children 17 
years of age or younger with a new diagnosis of craniopharyngioma. A 
retrospective case note review was performed for each child to extract data on 
the presentation, investigation, treatment, and outcome of their illness. 
Morbidity was assessed in the same fashion as in previous cohorts, according to 
the following categories: visual loss, pituitary dysfunction, hypothalamic 
dysfunction, neurological deficits, and cognitive impairment.
RESULTS: In total, 59 children were identified with craniopharyngioma during the 
study period. A total of 92 operations were performed, including cyst drainage 
(35/92; 38.0%), craniotomy and resection (30/92; 32.6%), and transsphenoidal 
resection (16/92; 17.4%). Approximately two-thirds of all operations were 
performed using image guidance (66/92; 71.7%) and one-third were performed using 
endoscopy (27/92; 29.3%). The majority of children had adjuvant therapy 
comprising proton beam therapy (18/59; 30.5%) or conventional radiotherapy 
(16/59; 27.1%). The median follow-up duration was 44 months (range 1-142 
months), and approximately one-half of the children had no evidence of residual 
disease on MRI studies (28/59; 47.5%). Of the remaining 31 children, there was a 
reduction in the volume of residual disease in 8 patients (8/59; 13.6%), stable 
residual disease in 18 (18/59; 30.5%), and tumor growth in 5 patients (5/59; 
8.5%). There was significantly reduced morbidity (p < 0.05) in all categories in 
the current cohort compared with our last cohort (1996-2004).
CONCLUSIONS: The authors' institutional experience of pediatric 
craniopharyngioma confirms a trend toward less invasive neurosurgical 
procedures, most of which are now performed with the benefit of image guidance 
or endoscopy. Moreover, the authors have identified an expanding role for more 
targeted radiotherapy for children with residual disease. These advances have 
allowed for tumor control comparable to that achieved in previous cohorts, but 
with significantly reduced morbidity and mortality.