Craniopharyngioma is a rare type of brain tumor that develops near several important structures. Because of its location, treating craniopharyngioma can be challenging. Neurosurgeons must be careful to avoid damaging the brain and pituitary gland. Centers for Neurosurgery, Spine & Orthopedics (CNSO) is New Jersey’s most comprehensive brain and spine center. Here, CNSO’s comprehensive medical team discusses craniopharyngioma treatments and how physicians decide which to apply.
Craniopharyngioma Treatments at a Glance
- Both brain tumor surgery and radiation therapy are standard treatments for craniopharyngioma, but they offer different benefits.
- Surgery can completely remove a tumor, but it requires a long recovery. Minimally invasive surgery, typically an endonasal (through the nose) approach, can reduce recovery times and minimize the risk of damage to healthy tissue.
- Radiation therapy effectively controls tumor growth with a shorter recovery. Advanced proton therapy improves precision for reduced radiation exposure to healthy brain tissue.
- The most appropriate treatment choice depends on the tumor size and location, the patient’s age, and their overall health.
Understanding Craniopharyngioma
Craniopharyngioma is a rare type of benign brain tumor that grows near the pituitary gland. This peanut-sized gland is located at the base of the brain and is responsible for regulating hormone production. As a craniopharyngioma grows, it can create pressure against the pituitary gland or damage the pituitary stalk (the connection between the brain and pituitary gland), impeding its function. It may also affect other structures in the brain, leading to symptoms such as:
- Headaches
- Nausea and vomiting
- Increased thirst or urination
- Loss of vision
- Double vision
- Loss of energy
- Weight gain
- Confusion and mood swings
Craniopharyngiomas grow slowly but can cause permanent health problems, including delayed puberty, hypogonadism, and hyperthyroidism. For this reason, treatment is always recommended. Treating a craniopharyngioma, however, is uniquely challenging due to its location near critical structures. Physicians must carefully weigh the risks and benefits while developing an appropriate care plan.
Surgical Approaches for Craniopharyngioma
Brain tumor surgery is the preferred first-line treatment for nearly all craniopharyngiomas. Surgery removes the tumor and relieves pressure on the brain, optic nerves, chiasm, and pituitary gland, often reducing or curing the symptoms. Depending on the tumor size and location, neurosurgeons may use one of two approaches:
Traditional Surgery
Traditional craniopharyngioma surgery uses a transcranial or “through the skull” approach. To perform the procedure, the surgeon removes a small piece of the patient’s skull to expose the tumor.
This technique provides excellent access to the whole craniopharyngioma for complete removal, making it ideal for eliminating large tumors. Though effective, transcranial surgery is highly invasive and associated with a lengthy recovery. It also comes with a small, but not negligible, risk of damage to the optic nerves, pituitary gland, or hypothalamus, potentially creating long-term health issues.
Minimally Invasive Surgery
Endoscopic craniopharyngioma surgery is a minimally invasive approach. Rather than cutting into the skull, the surgeon accesses the brain through the natural opening created by the sinuses. Using a tiny camera mounted on a flexible tube, the surgeon can remove the tumor without an incision.
Minimally invasive surgery has a reduced impact on the body, allowing for fewer risks and a faster recovery. Patients can also preserve their pre-surgery appearance without a visible scar. Not all tumors can be reached this way, however, and some are too large to remove through the sinuses. For this reason, not all patients are candidates for endoscopic craniopharyngioma surgery.
Radiation Therapy for Craniopharyngioma
Radiation therapy uses high-energy beams to kill tumor cells. While radiation therapy does not always remove a craniopharyngioma, it can shrink the tumor and prevent its spread. Like surgery, there are multiple methods of radiation therapy:
Conventional Radiation Therapy
Conventional radiation therapy targets the tumor with radiation, often requiring a series of treatments. Although the beam radiation is focused and primarily destroys tumor cells, including cells that are impossible to reach with surgery, other tissues in the brain are also exposed to radiation and may become damaged. This can have potential cognitive and hormonal side effects, especially when used repeatedly for a recurring tumor. It is also not recommended for young patients whose brains are still developing.
Proton Therapy
Proton therapy is an advanced approach that uses photons (high-energy electromagnetic radiation) to deliver radiation. Because the protons can be focused and stop at the tumor, there is no “exit radiation” caused by beam particles passing through the tumor. This ensures that all of the radiation is absorbed by the craniopharyngioma, reducing exposure to healthy brain tissue. Because of its increased precision, proton therapy causes fewer side effects. It is safer to use for recurring tumors and pediatric patients.
Key Considerations for Craniopharyngioma Treatment
Brain tumor surgery is the most effective treatment for craniopharyngiomas, especially if the tumor can be completely removed safely. Due to the location of these tumors, they are often very adherent to the optic nerves and chiasm (vision) and the pituitary stalk, making complete resection dangerous. For this reason, radiation therapy is almost always used as an adjunct to surgery. Patients work with a multidisciplinary care team, including neurosurgeons, oncologists, endocrinologists, and others, who collaborate to develop a fully personalized care plan. They take all factors into account, including:
- Effectiveness: Surgery can eliminate a tumor completely, providing the best long-term control with less chance of recurrence. However, it is not always a viable option.
- Risks: Surgery risks include hormonal imbalance, vision changes, and hypothalamic damage. Radiation risks include cognitive decline and secondary tumor growth.
- Tumor location: The tumor’s location in the brain can impact whether it can be accessed with surgery. It may also dictate which risks are most present.
- Tumor traits: Tumor size and composition, or whether it is cystic or solid, can affect how a craniopharyngioma responds to different types of treatment.
- Patient age: Developing brains are more vulnerable to damage from radiation, meaning that radiation therapy is recommended for adults more often than for children.
Evaluating all these factors, the care team will determine whether surgery or radiation therapy is the better approach. They may also decide upon a combined approach. For example, radiation therapy can be used to shrink a large tumor so that it can be removed with minimally invasive surgery. This dual treatment sometimes delivers better results than a single approach.
Find State-of-the-Art Brain Tumor Care Near You in New Jersey
Being diagnosed with a brain tumor is often frightening, but with the right treatment, patients can experience a successful recovery. Centers for Neurosurgery, Spine & Orthopedics delivers cutting-edge craniopharyngioma treatment at locations near you across New Jersey to help patients regain their quality of life with minimal side effects. Contact CNSO today to learn more about its services.
Frequently Asked Questions About Craniopharyngioma Treatments
What is the success rate of surgery for craniopharyngioma?
Craniopharyngioma surgery success rates vary widely depending on the tumor’s size and location, the surgical approach used, and the patient’s overall health. Chances are very good, however, with most patients going into full remission with no recurring tumors.
What is the success rate of radiation therapy for craniopharyngioma?
Like surgery, radiation therapy has a variable success rate depending on the patient’s unique case. For most patients, however, radiation therapy is highly successful at arresting the tumor and preventing it from growing, with few to no side effects from treatment.
Can craniopharyngiomas come back after treatment?
Like other tumor types, craniopharyngiomas can recur after treatment. The risk of side effects increases with a second treatment, though advances in brain tumor care are minimizing complications.
Are there new or experimental treatments available for craniopharyngiomas?
Ongoing research studies and clinical trials are investigating new therapies for brain tumors, including targeted therapies, immunotherapy, and advanced chemotherapy. Patients can speak with their care team about whether they are a good candidate for any clinical trials.
