Craniopharyngioma in children. An age-based analysis on our 11 year experience with the endoscopic endonasal approach

Objective: The aim of this work is to perform an age-based analysis to define the criteria for the best management from a clinical and surgical point of view of craniopharyngiomas in children on patients treated with an endoscopic endonasal approach. Methods: For this retrospective study, the databank of Meyer Children’s Hospital IRCCS was used. 29 consecutive patients treated with an endonasal endoscopic technique between January 2013 and January 2024 were enrolled in the study. All patients underwent endocrinological, ophthalmological and radiological examination upon admission. Standard follow-up appointments at the outpatient clinic were given to the patients at 1, 3 months and 6 months postoperatively and successively annual appointments were made. Results: The mean follow-up was 5.6 5.6 years ± 4.1 years. 40% of the patients presented with hydrocephalus, 41% of the children had an endocrine dysfunction as the primary symptom and visual impairment was present in 55% of the cases. Patients were subdivided into 3 groups according to age sub-stratification. Group A included young patients with ages between 3–6 years old (9 patients), Group B consisted of children in the pre-puberal age (7–12 years old – 12 patients) and Group C was formed by teenagers (13–18 years old – 8 patients). Group A presented more aggressive and voluminous tumors, with a higher recurrence and a higher risk of obesity. The period from first symptoms to diagnosis was significantly higher in Group C compared to Group B: 23.4 months versus 7.7 months respectively. Visual impairment was more frequent in Group A compared to Group C (p = 0.02). Conclusions: The age-based analysis showed some interesting findings. Younger children with an age inferior to 6 years old tend to present with more voluminous tumors and visual impairment as the first symptom, Once visual symptoms are manifested, they tend to be unchanged and do not show improvement, even after surgery. In teenagers the diagnosis can be delayed due to the misrecognition of the symptoms. However, our results showed that EEA is useful and feasible in all age groups, achieving a gross total/subtotal resection even in cases of recurrence. If used as the first treatment of choice the chances of gross total resection without further recurrence are higher.