• Sauradeep Sarkar, Shireen R Chacko, Sophy Korula, Asha Hesarghatta, Rajesh Balakrishnan, Sarah Mathai, Anna Simon, Geeta Chacko, Krishna Prabhu, and Ari G Chacko.
• Department of Neurological Sciences, Christian Medical College, Vellore, India. Electronic address: sauradeepsarkar@gmail.com.
• World Neurosurg. 2022 Jun 1; 162: e587-e596.

BackgroundThere is limited literature on outcomes after surgical treatment of giant craniopharyngiomas in adult and pediatric patients.MethodsA retrospective review of 159 patients undergoing surgery for craniopharyngiomas at a single institution was performed. Patients with giant craniopharyngiomas (maximum dimension ≥4.5 cm) were compared with nongiant tumors in terms of various clinical and radiological parameters and long-term surgical outcomes. Extent of resection was determined by postoperative magnetic resonance imaging. Factors associated with post-treatment obesity were also analyzed.ResultsGiant craniopharyngiomas (n = 66) were characterized by higher rates of childhood presentation, visual impairment, neurological deficits, multicompartmental involvement, and hydrocephalus as compared with nongiant tumors (n = 139). Giant tumors also were less likely to undergo transsphenoidal resection and were associated with a higher rate of postoperative neurological morbidity. There were no significant differences between the 2 groups in terms of extent of resection, use of postoperative radiation therapy, and long-term endocrinological outcomes. Overall recurrence rates over a mean follow-up period of 4.1 years were similar between giant and nongiant tumors; however, recurrences after presumed gross total resection/near total resection were significantly higher in the former subgroup versus the latter (39.4% vs. 18.4%; P = 0.044). Risk factors for post-treatment obesity in giant craniopharyngiomas included adult age (P = 0.001), preoperative obesity (P = 0.003), and hypothalamic involvement (P = 0.012).ConclusionGross total resection/near total resection of giant craniopharyngiomas can be achieved at rates comparable to nongiant tumors. However, there remains a greater risk of postoperative neurological morbidity. Radiation therapy mitigates the risk of recurrence on long-term follow-up.Copyright © 2022 Elsevier Inc. All rights reserved.

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