BACKGROUND AND OBJECTIVE Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. MATERIAL AND METHODS The MEDLINE database was systematically reviewed (January 1970-February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. RESULTS The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied for tumor recurrences. Radiotherapy or intracystic agents are alternative treatments when no further surgery is possible. A multidisciplinary long-term follow-up is necessary.

中文翻译：

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成人患者颅咽神经瘤的外科治疗：代表EANS颅底部分的系统评价和共识声明。

背景与目的颅咽管瘤是浸润附近关键神经血管结构的局部侵袭性神经上皮肿瘤。大多数已发表的外科手术系列均涉及儿童期发病的颅咽管瘤，而成年期肿瘤的最佳手术治疗仍不清楚。本文的目的是通过广泛的系统文献综述，总结定义成年患者颅咽管瘤手术策略的主要原则，以提出一系列建议。材料与方法对MEDLINE数据库（1970年1月至2019年2月）进行了系统地审查，以鉴定与成人发作性颅咽管瘤手术治疗有关的文章。在EANS头骨底座部分讨论之后，提出了文献证据的摘要。结果EANS工作队制定了13条建议和4条建议。这些患者的治疗应在三级转诊中心进行。由于改善的GTR以及出色的内分泌和视觉效果，目前建议将鼻腔入路用于中线颅咽管瘤。通过使用多层重建技术，CSF泄漏率已大大降低。对于表现为侧向伸展或单纯脑室内的肿瘤，建议采用经颅入路。与技术无关，应进行最大但保留下丘脑的切除术，以限制术后下丘脑综合征和代谢并发症的发生。类似的原则也应适用于肿瘤复发。如果无法进行进一步的手术，则放射疗法或囊内药剂是替代疗法。必须进行多学科的长期随访。