Craniopharyngioma: The pendulum of surgical management

Background: For a long time, craniopharyngiomas have been considered surgically attractive tumours. The fact that they are rare, histologically benign, and located in a challenging (but considered accessible) area made them worthy surgical prizes. Methods: As we have saved vision and "cured" many of these tumours, the insidious and devastating effects on quality of life for these children has become evident. Discussion: The state-of-the-art in the surgical management of craniopharyngioma is now turning to multi-modality treatment strategies (combination surgery and radiotherapy) aiming to limit morbidity. Questions remain - what factors influence our surgical decision making? Do we understand the long-term effects of the radiotherapy now being employed? We review a series of craniopharyngiomas looking for variables that correlated with outcome as perceived in terms of quality of life and we review briefly the history of craniopharyngioma surgery and the relevant literature.