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

Childs Nerv Syst. 2017 Jun;33(6):941-950. doi: 10.1007/s00381-017-3411-4. Epub 2017 Apr 28.


Background: 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.

Patients and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Craniopharyngioma; Low middle income country; Multidisciplinary care.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Craniopharyngioma / diagnosis
  • Craniopharyngioma / economics*
  • Craniopharyngioma / therapy*
  • Disease Management*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Morbidity
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / economics*
  • Pituitary Neoplasms / therapy*
  • Poverty / economics*
  • Poverty / trends
  • Retrospective Studies
  • Time Factors