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Endoscopic Versus Transcranial Craniopharyngioma Surgery in New Jersey

Parent with craniopharyngioma and child in exam room with neurosurgeon giving child high five

Craniopharyngioma, a rare type of benign brain tumor, is typically treated by its removal either endoscopically or through transcranial surgery via a craniotomy. The skilled neurosurgeons at Centers for Neurosurgery, Spine & Orthopedics (CNSO) are well-versed in every approach and have experience treating a wide range of brain tumors.

Based in northern New Jersey, CNSO has multiple locations where patients can receive comprehensive brain and spine care. Learn more about craniopharyngioma treatments and what to expect during surgery.

What Is Craniopharyngioma?

A craniopharyngioma is a benign, slow-growing tumor that develops near the pituitary gland. Craniopharyngiomas typically occur in children ages five to 14, as well as in adults. Craniopharyngioma tumors affect one or two out of every million patients each year.

What Is Endoscopic Surgery versus Transcranial Surgery?

Endoscopic surgery is when small incisions and dilators are used to access the surgical field, leaving minimal scarring. This expedites the healing process. A craniopharyngioma can be removed endoscopically via the nostril, leaving no visible scar. Transcranial surgery means “through the skull.” In this type of brain surgery, a neurosurgeon removes a small piece of the patient’s skull to access the brain tissue.

Diagnosis and Preoperative Evaluation

It is not clear what causes craniopharyngioma or what the risk factors are. Craniopharyngiomas do not usually spread to other parts of the brain. But because they grow close to the optic pathway, pituitary gland, and hypothalamus, they can disrupt vision and hormone function. Signs and symptoms of craniopharyngioma can include:

  • Vision loss
  • Headache
  • Confusion and fatigue
  • Delayed puberty
  • Weight gain
  • Frequent urination and extreme thirst
  • Loss of appetite
  • Nausea or vomiting
  • Mood swings or changes in behavior
  • Slowed growth in children

These symptoms can be attributed to many other conditions, so patients may require several different tests to confirm a diagnosis of craniopharyngioma, such as:

  • Imaging tests, such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan
  • Blood work
  • Urinalysis
  • Vision tests
  • Biopsy
  • Neuropsychological evaluation
  • Cerebral angiography

Preparing for Surgery

Surgery is the primary treatment option for craniopharyngioma. The goal of surgical resection is to remove as much of the tumor as possible without damaging crucial brain structures. It is important to choose the right neurosurgical team with an understanding of craniopharyngioma and extensive experience in the surgical removal of this type of tumor.

The team at CNSO will discuss the surgical approach with the patient and answer any questions they may have regarding the risks and benefits of craniopharyngioma treatment. They may also coordinate with oncology specialists if the patient will need radiation therapy after surgery to remove remaining tumor cells.

Surgical Techniques for Craniopharyngioma

Craniopharyngioma surgery may be performed using a transsphenoidal approach, in which endoscopic craniopharyngioma surgery is done through the nostrils. The surgical plan is personalized to the patient based on the size and location of the tumor.

Transcranial brain surgery removes the tumor through an opening in the skull, a procedure known as a craniotomy. When possible, the neurosurgeon will use minimally invasive techniques to limit blood loss and make the recovery process easier. Anesthesia is administered during a craniotomy so the patient does not feel any pain during surgery. To access the tumor, the surgical team will clean the scalp, create an incision, and remove a piece of the skull.

Craniopharyngioma surgery is designed to remove as much of the tumor as possible without damaging the optic nerves, hypothalamus, or pituitary gland. Post-surgery radiation therapy is typically recommended if the entire tumor cannot be removed safely.

Intraoperative Procedures

The patient’s vital signs are monitored throughout the surgery. The surgical team will use advanced imaging techniques to navigate critical brain structures and visualize the tumor throughout the procedure. Craniopharyngiomas can be solid or cystic, so in some cases, surgery will also include the drainage of cyst fluid.

Postoperative Care and Recovery

After craniopharyngioma surgery is complete, a patient moves to a recovery room in the hospital, where they will be monitored closely. After the patient wakes up from anesthesia, they may experience nausea or headache. They must stay in the hospital for several days for ongoing monitoring and testing, including blood work, imaging, or urinalysis.

Once the patient clears for discharge, they will receive instructions for recovery at home. It may take one to two weeks before a patient can return to work or school. They will have follow-up appointments with their medical team and may work with rehabilitation specialists. A patient’s rehabilitation plan will depend on where the tumor was located and any long-term effects it caused. Follow-up care also will include MRIs or CT scans to check if any tumor cells remain.

Pediatric Craniopharyngioma Surgery

Although craniopharyngiomas are rare, they are more common among children than adults. Children with craniopharyngioma need to be carefully evaluated and should have their surgical plan developed by a team of providers with expertise in treating pediatric tumors. Craniopharyngioma in children can recur after treatment and may cause long-term issues with hormone production or function. Some pediatric patients need hormone replacement therapy after surgery.

Long-term Outcomes and Challenges

Even after surgery, there is a chance that craniopharyngioma can recur. Patients with craniopharyngioma may need long-term care and monitoring. Additional surgeries may be required if the tumor grows back. Even after a craniopharyngioma has been removed, a patient may experience long-term effects such as:

  • Vision loss: Craniopharyngioma can cause vision loss or even partial blindness
  • Hypothalamic dysfunction: Some patients with craniopharyngioma experience hypothalamic obesity, which makes it challenging to maintain a healthy weight
  • Cerebrovascular issues: Surgery and radiation therapy for craniopharyngioma may increase the risk of future cardiovascular events
  • Diabetes insipidus: This condition can be caused by issues with pituitary function and makes a person feel very thirsty and urinate frequently

Childhood craniopharyngioma can also result in neurocognitive issues, such as problems with executive function, memory, and attention. Fortunately, ongoing medical research and clinical trials mean new options for craniopharyngioma treatment are being pursued. For example, new medications may help delay or eliminate the need for ongoing radiation therapy treatment.

Choosing the Right Hospital and Surgeon

When evaluating options for brain tumor treatment, patients must choose the right hospital and surgical team to provide the best care. CNSO is proud to have a team of knowledgeable, board-certified neurosurgeons with hospital affiliations throughout the area, including:

  • Morristown Medical Center
  • Joseph’s Hospital
  • Valley Hospital
  • Chilton Hospital
  • Holy Name Medical Center
  • Hudson Regional Hospital

The Role of Multidisciplinary Care

CNSO takes a comprehensive approach to care. In addition to neurosurgeons, CNSO’s medical staff includes interventional pain management physicians, physiatrists, orthopedic spine surgeons, rehabilitation specialists, and certified physical therapists. The team works in collaboration at all stages, from surgery to non-opioid pain management and rehabilitation, to ensure appropriate care. From the first consultation to the last follow-up visit, patients at CNSO can be confident in the level of personalized care they receive from this team of dedicated specialists.

Addressing Recurrence and Residual Tumor

In some cases, the entire craniopharyngioma can be removed during a craniotomy. If tumor cells remain, however, a patient may need additional treatment through radiation therapy or chemotherapy. Radiation therapy uses high-energy beams to shrink or destroy tumors, whereas chemotherapy uses drugs (usually administered intravenously) to target tumor cells.

Radiation is the more common option, although chemotherapy may be used in treating a certain subtype of this disease, known as papillary craniopharyngioma. Because there is a chance of recurrence, a patient who has undergone craniopharyngioma treatment usually will need annual imaging tests to check for new tumor cells. This usually is an MRI.

Frequently Asked Questions About Craniopharyngioma

Some commonly asked questions regarding craniopharyngioma treatment include:

What is the typical recovery period after craniopharyngioma surgery?

After craniopharyngioma surgery, patients typically are discharged from the hospital in less than a week. However, complete recovery can take several months.

Can craniopharyngioma recur after surgery?

Yes, these types of tumors can come back, especially if a craniopharyngioma is only removed partially. Craniopharyngiomas that recur typically do so within three years after surgery.

Are there any nonsurgical treatment options for craniopharyngioma?

Surgery generally is the best treatment approach for craniopharyngioma. After surgery, some patients will have additional treatments, such as radiation therapy or chemotherapy.

What are the potential risks of surgery?

Surgery always carries a degree of risk, but transcranial craniopharyngioma surgery is planned carefully to minimize damage to healthy tissue as much as possible. Removal of craniopharyngioma could result in long-term issues with hormone production, as well as vision problems. As with all types of surgery, there is a risk of infection, blood loss, and allergic reaction to anesthesia medication.

Are there any support groups for patients with families?

Online and in-person support groups and other resources may be available for patients and their loved ones. Patients are encouraged to talk with their healthcare provider or visit the National Organization for Rare Disorders, Inc. for more information.

Find Expert Neurosurgery at CNSO

Adults with craniopharyngioma can find an experienced team of neurosurgeons at Centers for Neurosurgery, Spine & Orthopedics (CNSO), with locations throughout northern New Jersey. As the state’s most comprehensive center, CNSO offers treatment for a wide range of brain and spine conditions. Additionally, CNSO has providers fluent in Spanish, Korean, Russian, Serbo-Croatian, and Mandarin Chinese, so patients can receive care in the language they are most comfortable with speaking.

CNSO takes a conservative approach to care, using evidence-based practices to treat patients with both surgical and nonsurgical treatments. For more information about craniopharyngioma surgery or to schedule an initial consultation, contact CNSO today.

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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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