Review of management and morbidity of pediatric craniopharyngioma patients in a low-middle-income country: a 12-year experience

• DOI: 10.1007/s00381-017-3411-4
• Publication Date: 2017-04-28T00:42:12Z
• Authors: Nisreen Amayiri; Maisa Swaidan; Yocoub Yousef; Hadeel Halalsheh; Ramiz Abu-Hijlih; Sima Kalaldeh; Maha Barbar; Maher Elayyan; Nesreen Faqih; Maysa Al-Hussaini; Mustafa Mehyar; Ute Bartels; James Drake; Awni Musharbash; Eric Bouffet
• Keywords: Male; Time Factors; Adolescent; Disease Management; Infant; 3. Good health; Craniopharyngioma; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Female; Pituitary Neoplasms; Morbidity; Child; Poverty; Follow-Up Studies; Retrospective Studies

Management of craniopharyngioma in children is challenging, and their quality of life can be significantly affected. Series describing this from low-middle income countries (LMIC) are few.The study provides a retrospective chart review of pediatric patients <18 years old, diagnosed with craniopharyngioma between 2003 and 2014, and treated at King Hussein Cancer Center, Jordan.Twenty-four patients (12 males) were identified. Median age at diagnosis was 7.4 years (0.9-16.4 years). Commonest symptoms were visual impairment and headache (71%). Review of seventeen preoperative MRIs showed hypothalamic involvement in 88% and hydrocephalus in 76%. Thirteen patients (54%) had multiple surgical interventions. Five patients (21%) had initial gross total resection. Eleven patients (46%) received radiotherapy and six (25%) intra-cystic interferon. Five years' survival was 87 ± 7% with a median follow-up of 4.5 years (0.3-12.3 years). Four patients (17%) died; one after post-operative cerebral infarction and three secondary to hypothalamic damage. At their last evaluation, all but one patient required multiple hormonal supplements. Ten patients (42%) had best eye visual acuity (VA) >20/40, and four (16%) were legally blind. Eleven patients (46%) were overweight/obese; one had gastric bypass surgery. Seven patients had hyperlipidemia, and eight developed fatty liver infiltration. Eleven patients (65%) were attending schools and one at college. Nine of the living patients (53%) expressed difficulty to engage in the community.Management of pediatric craniopharyngioma is particularly complex and demanding in LMIC. Multidisciplinary care is integral to optimize the care and minimize the morbidities. A management outline for LMIC is proposed.