CRANIOPHARYNGIOMA IN THE ELDERLY: A MULTICENTER AND NATION-WIDE STUDY IN SPAIN.

BACKGROUND Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. AIM To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. PATIENTS AND METHODS A retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated was performed. RESULTS From a total of 384 adult CP patients, we selected 53 (13.8%) patients [27 women (50.9%), mean age 72.3 ± 5.1 years (range 65-83 yr)] diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). Maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%) and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP (ACP) and papillary CP (PCP) were present in 51% and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9% to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs 53.6%, p=0.008). Patients were followed for 46.7±40.8 months. Mortality rate was 39.6% with a median survival time of 88 (95% CI, 57-118) months. DI at last visit was associated with a lower survival. CONCLUSION CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.