Advances and challenges in adult-onset craniopharyngioma

Adult-onset craniopharyngioma is a rare intracranial neoplasm of embryonic origin that significantly affects morbidity and mortality due to its impact on pituitary and hypothalamic functions. Despite its rarity, the tumor presents substantial challenges, particularly in the form of severe metabolic complications post-surgery, for which effective treatments are lacking. The standard treatment involves surgical resection, but this often leads to recurrence, with each surgery exacerbating hypothalamic damage. Alternative approaches, such as limited resection combined with radiation therapy, aim to preserve hypothalamic function while minimizing tumor progression. However, these methods introduce risks of vasculopathies, secondary malignancies, encephalopathy, and radionecrosis. Consequently, patients with craniopharyngioma face a significantly increased risk of mortality from cardio- and cerebrovascular diseases, as well as complications like hydrocephalus, tumor recurrence, obesity, and panhypopituitarism. While the incidence of craniopharyngioma shows a bimodal distribution, adult-onset cases remain under-researched, with studies often limited by small sample sizes and short durations. The optimal management strategy for these tumors remains unclear, and the distinct genetic and pathophysiological characteristics of the adamantinomatous and papillary variants further complicate treatment decisions. Current research predominantly focuses on childhood-onset craniopharyngioma, leaving a gap in understanding the long-term metabolic and biopsychosocial impacts in adults.

This research topic aims to heighten awareness among clinicians regarding the significant long-term impacts on quality of life and metabolic function faced by patients with adult-onset craniopharyngioma. By stimulating interest in this under-researched area, we hope to encourage translational research that addresses existing gaps in care. The objective is to foster a deeper understanding of the disease and its management, ultimately improving patient outcomes and quality of life.

To gather further insights into the complexities of adult-onset craniopharyngioma, we welcome articles addressing, but not limited to, the following themes:
- Approaches for initial treatment, including surgical strategies and the role of adjuvant radiation.
- Novel therapies for tumor recurrence.
- Genetic and pathophysiological studies, including transcriptomic analyses.
- Precision medicine approaches tailored to craniopharyngioma.
- Long-term sequelae, focusing on hypopituitarism, quality of life, metabolic complications, and hypothalamic obesity.
- Management strategies for craniopharyngioma sequelae in adults.
- The biopsychosocial impact of adult-onset craniopharyngioma.
- Fertility implications associated with the disease and its treatment