Q: What is craniopharyngioma? What are the manifestations of craniopharyngioma in children? A: Craniopharyngioma is the most common congenital tumor in the cranium, which occurs in children and is less common in adults. Children and adolescents often have endocrine dysfunction, such as developmental dwarfism, excessive drinking and urination, obesity, genital dysplasia, etc. If the tumor continues to grow, headache, nausea and vomiting, visual and visual field disorders, urolithiasis, as well as neurological and psychiatric symptoms may occur. Q: Is it necessary to treat craniopharyngioma? Can pediatric patients who are too young for surgery be observed first? Can it be treated with medication first? A: Craniopharyngioma is a benign tumor. With the development of neuroimaging and microscopic neurosurgery, it can theoretically be cured by complete surgical resection. Craniopharyngiomas can be found in asymptomatic adults who are diagnosed by imaging. Children with craniopharyngiomas usually present with early symptoms such as developmental delay, so the child’s age, general condition, and the imaging of the tumor are important factors in deciding whether to pursue treatment. There is no single drug that is effective in controlling the growth of craniopharyngiomas, and the preferred modality of treatment for craniopharyngiomas is surgical resection. Q: Under what circumstances can the tumor be completely resected? What are the requirements for the growth site and the nature of the tumor when total excision is performed? A: Whether or not a craniopharyngioma can be completely removed is closely related to the size, location and structure of the tumor as well as the surgeon’s microscopic neurosurgical skills. Q: How can I tell that the tumor has been completely removed? Can I say that the tumor has been completely removed if the follow-up CT or MRI after surgery shows that the tumor has disappeared? A: The degree of surgical resection is mainly determined by CT or MRI. If the CT or MRI is reviewed 5 years after surgery and there is no tumor, it can be said that the tumor has been completely removed. Q: Will craniopharyngiomas be prone to recurrence after total resection surgery? A: The important factors affecting postoperative recurrence are the extent of surgical resection and the presence or absence of postoperative radiation therapy. The main cause of recurrence is the presence of residual tumor cells and infiltration of tumor cells into the hypothalamus. In addition the histologic subtype of craniopharyngioma affects recurrence. There are some types of craniopharyngiomas that have a low recurrence rate. Even after total resection of a craniopharyngioma, there is still a recurrence rate of about 10%. Usually recurrence occurs most often within 5 years of surgery. Q: When can a tumor only be partially removed? A: Tumors with fewer adhesions to the surrounding area are easier to resect. If the craniopharyngioma is tightly attached to the surrounding tissues (pituitary gland, hypothalamus, internal carotid artery, skull base arterial ring, optic nerve crossings and optic bundles, etc.), or if the tumor is deeply embedded in the grey nodule, or if the tumor is hard, the total resection of the tumor will result in more post-surgical complications and a higher mortality rate. Therefore, partial resection is sometimes the only option. If there are obvious preoperative clinical symptoms of pituitary and hypothalamic dysfunction, only partial resection of the tumor is suitable. Q: Is radiation therapy needed after total resection of craniopharyngioma? A: Radiotherapy is considered to be an effective adjuvant for subtotal resection of primary tumor and treatment of recurrent tumor. Some physicians do not advocate radiotherapy for patients with total tumor resection, especially for pediatric patients with craniopharyngiomas, which can lead to decreased learning ability and impaired intellectual development after receiving radiotherapy. Other complications of radiotherapy include radiation-induced tumor formation, radiation brain necrosis, radiation vascular occlusion, radiation vascular inflammation, optic neuritis, dementia, basal ganglia calcification, hypothalamic-pituitary dysfunction and hypothalamic obesity. However, for adult patients with craniopharyngioma, postoperative local radiotherapy can prevent or delay tumor recurrence. For surgical residual tumors, radiotherapy needs to be considered.