Resection of craniopharyngiomas: comparison between gross total resection and subtotal resection with adjuvant radiation

Purpose: The surgical treatment of craniopharyngiomas (CPs) remains a challenge, with significant variability in the literature. Methods: we therefore analyze current studies to demonstrate how the field has changed over the years. Results: Achieving a gross total resection for these histologically benign lesions often poses significant difficulty based on their proximity, adherence, or invasion of adjacent critically important neuronal and vascular structures. In our historical literature, gross-total resection from transcranial surgery often carried high morbidity leading some to advocate for subtotal resection paired with postoperative radiotherapy as a preferable strategy. The advent of the extended endonasal endoscopic approach has led to a reconsideration of this tactic. Conclusions: In this review, we discuss several of the studies that led to the current understanding of surgical options for craniopharyngiomas and discuss how the endonasal approach and more recent published results may modify surgical thinking.