ID #582 Therapeutic Patterns and Outcomes of Craniopharyngioma in Early Childhood: A Canadian Multicenter Registry Study

Abstract Background Craniopharyngiomas (CP) are benign brain tumors, but their proximity to important neuroendocrine structures increases the morbidity of both disease and treatment. Guiding evidence for optimal treatment is limited, especially in the very young. Methods We conducted a retrospective review of patients diagnosed with CP, 6 years and under, using our CanPedsCranio registry which included eligible patients diagnosed with CP and treated at one of 7 participating Canadian pediatric institutions. Our objectives were to characterize treatment approaches, overall survival, and clinical outcomes. Results Twenty-two patients in the registry were diagnosed with CP at 6 years old between 2000 and 2025 (median age 3.6 years, range 0.8-5.8). Initial interventions included subtotal(n = 3) or gross total resection(n = 3) in 27.3%; intracystic catheter insertion only in 40.9% (n = 9); cerebrospinal fluid (CSF) diversion in 9.1%(n = 2); combination of biopsy, cystic procedure(s), and CSF diversion in 13.6%(n = 3); and undefined surgery in 9.1%(n = 2). Surgical resection during treatment course occurred in 63.6% (n = 14) of patients. Radiotherapy, intracystic bleomycin (used years 2001-2004), and intracystic interferon were used in 27.3% (n = 6), 13.6% (n = 3), and 18.2% (n = 4), respectively. Overall survival was 77.3% with a median follow-up of 42 months. Visual impairment was documented in 27.3% (n = 6) and 68.1% (n = 15) at the time of presentation and during follow-up, respectively. Pituitary dysfunction affected 9.1% (n = 2) at time of presentation and 81.8% (n = 18) throughout follow-up. Obesity was reported in follow-up in 27.3% (n = 6), with 3 patients developing obesity following resection of CP (range 1-78 months after surgery). Conclusion Most of our young child Canadian cohort did not undergo surgical resection as the first intervention. Overall survival in this young group is inferior to all pediatric CP usually referenced at 92-100%, 1. Castle-Kirszbaum, M., Shi, M.D.Y. & Goldschlager, T. Quality of Life in Craniopharyngioma: A Systematic Review. World Neurosurg. 164, 424-435.e2(2022) 2. Drapeau, A. et al. Pediatric craniopharyngioma. Childs Nerv. Syst. 35,2133-2145(2019). 3. Otte, A. & Muller, H.L. Childhood-onset Craniopharyngioma. J. Clin. Endocrinol. Metab. 106,e3820-e3836(2021)