Management of the Recurrence of Craniopharyngiomas

Tumor recurrence is the most common complication of any primary treatment modality for craniopharyngiomas. A multidisciplinary approach is helpful for determining the optimal treatment strategy when a recurrent tumor is identified. Surgical resection via transcranial or transsphenoidal approaches can be curative in the vast majority of patients who have recurrences, but there is a higher rate of morbidity in a reoperation following a primary radical resection. Adjuvant radiation therapy, intracystic irradiation or bleomycin, and serial aspirations in cystic tumors are alternative or complimentary treatment options for recurrent tumors. These options have lower morbidity but also provide less opportunity for salvage and cure and may only be appropriate when palliation is the end therapeutic goal. Regardless of strategy, patients and their families need to be informed and assessed for their ability to tolerate new deficits following reoperation.