Treatment

Surgical Treatment

If the craniopharyngioma is minimally or not symptomatic, initial surveillance can be proposed during the first consultation. On the other hand, if the craniopharyngioma is progressive and becomes symptomatic (visual disturbances, hypothalamic disorders), surgical intervention is necessary in a specialized surgical center. Surgery aims to remove as much of the tumor as possible (maximal resection) while preserving hypothalamic function, so as to avoid loss of hypothalamus function. As soon as the tumor infiltrates the hypothalamus, the entire tumor cannot generally be removed. Thus, in this case, a remnant is usually left at the level of the hypothalamus. This remnant, if it threatens visual pathways or if it is progressive, may be treated by radiotherapy. Finally, it is frequently impossible to preserve pituitary function, which requires taking hormone replacement therapy post-operatively. Depending on the development of the craniopharyngioma, the tumor can be removed via the endoscopic endonasal route (through the nose) in the majority of cases, or via a transcranial route (transcranial microsurgery). It is a delicate surgery, but associated with a low complication rate in experienced teams.

Hormonal Treatment

Treatment of a craniopharyngioma requires the presence of an endocrinologist, for diagnosis, follow-up, and treatment of hormonal deficits. Indeed, whether at diagnosis, during follow-up, or after surgery, it is very common for hormonal deficits to occur. Endocrinological management allows detecting these hormonal deficits and substituting them if necessary with medical treatment (medication that replaces the hormone that can no longer be secreted).

Radiotherapy Treatment

As explained above, if the entire tumor cannot be removed by surgery, radiotherapy may be indicated to prevent growth of the tumor residue left after the procedure. Radiosurgery can sometimes also be proposed in cases of small volume at a distance from optic pathways (optic nerves and chiasm). Radiotherapy modalities (proton therapy, conformal radiotherapy, ZapX) are discussed in conjunction with radiotherapists expert in this pathology (Dr. Nataf, Lariboisière; Dr. Calugaru, IGR; Dr. Jacob, Pitié-Salpêtrière, Dr. Dhermain, Institut Gustave Roussy).