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Javadpour M, Amoo M, Crimmins D, Caird J, Daly P, Pears J, Owens C, Capra M, Cody D. Endoscopic extended transsphenoidal surgery for newly diagnosed paediatric craniopharyngiomas. Childs Nerv Syst 2021; 37:1547-1561. [PMID: 33665678 DOI: 10.1007/s00381-021-05108-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/01/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Endoscopic extended transsphenoidal surgery (EETSS) has gained popularity for treatment of craniopharyngiomas. The aim of this study is to assess the outcome of endoscopic extended transsphenoidal surgery (EETSS) for newly diagnosed paediatric craniopharyngiomas. METHODS Patient details were obtained from a prospective database of all endoscopic transnasal operations performed by a single surgeon. Outcomes including visual function, pituitary function, body mass index (BMI), postoperative neurological deficit, extent of resection and recurrence on follow-up were obtained. Obesity was defined as BMI percentile of equal to or greater than 95%. RESULTS Between January 2011 and January 2020, 15 of 16 children (5-18 years old) with newly diagnosed craniopharyngiomas underwent EETSS. Four patients had a conchal-type sphenoid sinus. Gross total resection (GTR) was achieved in 4 patients and near total resection (NTR) in 5 patients. The remaining 6 had subtotal resection (STR). Postoperative radiotherapy was used in 6 patients (4 with STR, 2 with NTR). There were no postoperative deaths, strokes or CSF leaks. Normalisation of visual fields (VF) occurred in 9/13 patients with preoperative VF defects. One patient developed a new visual field defect. During a median follow-up period of 74 (8-104) months, 2 patients have required further surgery for tumour progression following initial STR, where a tumour remnant was left in situ to preserve the pituitary stalk. 6/11 patients developed new anterior pituitary dysfunction as a result of surgery and 9/12 developed new diabetes insipidus (DI). At the time of last follow-up, 14/15 children had anterior panhypopituitarism, 13/15 had DI and 1 patient developed new onset obesity. Two patients, who were obese preoperatively, were no longer obese at last follow-up. CONCLUSIONS EETSS can be performed as the first option in the majority of children with newly diagnosed craniopharyngioma, despite factors such as small nose, non-pneumatised sphenoid sinus, small sella or purely suprasellar tumour location. Preservation of the pituitary stalk at the expense of leaving residual tumour may not be in the best interests of the patient.
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Affiliation(s)
- Mohsen Javadpour
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
- Trinity College Dublin, Dublin, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Michael Amoo
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Darach Crimmins
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Caird
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patricia Daly
- Trinity College Dublin, Dublin, Ireland
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Jane Pears
- Departments of Paediatric Oncology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Cormac Owens
- Departments of Paediatric Oncology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Michael Capra
- Departments of Paediatric Oncology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Declan Cody
- Departments of Paediatric Endocrinology, Children's Health Ireland at Crumlin, Dublin, Ireland
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Peng J, Yang L, Pan J, Wang C, Nie J, Liu Y, Fan J, Zhou J, Qi S. Clinical features and prognosis of pediatric infradiaphragmatic craniopharyngioma relative to the tumor inflammatory response. Pediatr Res 2021; 89:1119-1125. [PMID: 32559758 DOI: 10.1038/s41390-020-1013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between clinical responses in pediatric infradiaphragmatic craniopharyngioma (Q-CP) and inflammatory response is still unclear. The objective of this study was to investigate the clinical significance of tumor inflammatory response in pediatric Q-CPs. METHODS The inflammatory response was evaluated by measuring the number of inflammatory cells in the tumor near adenohypophysis junction. The specimens were classified as mild, moderate, or severe based on the number of inflammatory cells. In addition, the levels of pro-inflammatory cytokines and chemokines in the specimens were measured using a cytokine antibody array. Clinical outcomes were analyzed and compared to the markers of inflammatory response. RESULTS IL-6 and IL-8 were highly expressed in pediatric Q-CPs, and the transcription level of IL-6 was the highest in the severe group. Most patients (87.3%) had hypopituitarism; the severe inflammation group had an increased incidence of hypopituitarism, which correlated with significantly lower probability of recurrence-free survival and worsened functional status. CONCLUSIONS Inflammatory response is common in craniopharyngiomas and is closely related to their biological behavior and the patients' clinical prognosis. Further studies of the relationship between craniopharyngiomas and the inflammatory response will enable the discovery of potential therapeutic targets, which will reduce morbidity and result in better outcomes for pediatric Q-CP patients. IMPACT Pediatric infradiaphragmatic craniopharyngiomas are histologically benign brain tumors that often follow an aggressive clinical course. The inflammatory response in craniopharyngioma is common, which is closely related to the biological behavior and clinical prognosis. Several inflammatory and immune markers have been identified in CP; inflammation is an important role in the pathogenesis of hypopituitarism. The aim was to study the relationship between craniopharyngioma and inflammatory response and find potential therapeutic targets can reduce morbidity and result in better outcomes.
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Affiliation(s)
- Junxiang Peng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Lang Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jun Pan
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chaohu Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jing Nie
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yi Liu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jun Fan
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jie Zhou
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Typical Pediatric Brain Tumors Occurring in Adults-Differences in Management and Outcome. Biomedicines 2021; 9:biomedicines9040356. [PMID: 33808415 PMCID: PMC8066180 DOI: 10.3390/biomedicines9040356] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Adult brain tumors mostly distinguish themselves from their pediatric counterparts. However, some typical pediatric brain tumors also occur in adults. The aim of this review is to describe the differences between classification, treatment, and outcome of medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adults and children. Medulloblastoma is a WHO IV posterior fossa tumor, divided into four different molecular subgroups, namely sonic hedgehog (SHH), wingless (WNT), Group 3, and Group 4. They show a different age-specific distribution, creating specific outcome patterns, with a 5-year overall survival of 25–83% in adults and 50–90% in children. Pilocytic astrocytoma, a WHO I tumor, mostly found in the supratentorial brain in adults, occurs in the cerebellum in children. Complete resection improves prognosis, and 5-year overall survival is around 85% in adults and >90% in children. Craniopharyngioma typically occurs in the sellar compartment leading to endocrine or visual field deficits by invasion of the surrounding structures. Treatment aims for a gross total resection in adults, while in children, preservation of the hypothalamus is of paramount importance to ensure endocrine development during puberty. Five-year overall survival is approximately 90%. Most treatment regimens for these tumors stem from pediatric trials and are translated to adults. Treatment is warranted in an interdisciplinary setting specialized in pediatric and adult brain tumors.
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Steiert C, Grauvogel J, Roelz R, Demerath T, Schnell D, Beck J, Coenen VA, Reinacher PC. Stereotactic cysto-ventricular catheters in craniopharyngiomas: an effective minimally invasive method to improve visual impairment and achieve long-term cyst volume reduction. Neurosurg Rev 2021; 44:3411-3420. [PMID: 33674982 PMCID: PMC8592958 DOI: 10.1007/s10143-021-01510-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/07/2021] [Accepted: 02/22/2021] [Indexed: 01/07/2023]
Abstract
Craniopharyngiomas are typically located in the sellar region and frequently contain space-occupying cysts. They usually cause visual impairment and endocrine disorders. Due to the high potential morbidity associated with radical resection, several less invasive surgical approaches have been developed. This study investigated stereotactic-guided implantation of cysto-ventricular catheters (CVC) as a new method to reduce and control cystic components. Twelve patients with cystic craniopharyngiomas were treated with CVC in our hospital between 04/2013 and 05/2017. The clinical and radiological data were retrospectively analysed to evaluate safety aspects as well as ophthalmological and endocrine symptoms. The long-term development of tumour and cyst volumes was assessed by volumetry. The median age of our patients was 69.0 years and the median follow-up period was 41.0 months. Volumetric analyses demonstrated a mean reduction of cyst volume of 64.2% after CVC implantation. At last follow-up assessment, there was a mean reduction of cyst volume of 92.0% and total tumour volume of 85.8% after completion of radiotherapy. Visual acuity improved in 90% of affected patients, and visual field defects improved in 70% of affected patients. No patient showed ophthalmological deterioration after surgery, and endocrine disorders remained stable. Stereotactic implantation of CVC proved to be a safe minimally invasive method for the long-term reduction of cystic components with improved ophthalmological symptoms. The consequential decrease of total tumour volumes optimised conditions for adjuvant radiotherapy. Given the low surgical morbidity and the effective drainage of tumour cysts, this technique should be considered for the treatment of selected cystic craniopharyngiomas.
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Affiliation(s)
- Christine Steiert
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Schnell
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106, Freiburg, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, D-79106, Freiburg, Germany. .,Fraunhofer Institute for Laser Technology, Aachen, Germany.
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Sarkar S, Chacko SR, Korula S, Simon A, Mathai S, Chacko G, Chacko AG. Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas. Acta Neurochir (Wien) 2021; 163:499-509. [PMID: 33078364 DOI: 10.1007/s00701-020-04591-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas. METHODS This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5-127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed. RESULTS Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011). CONCLUSIONS Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up.
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Ismail M, Zidan W, Hamead K, Abdelhak B, Darwish M. Endoscopic transsellar transdiaphragmatic approach for extensive suprasellar pituitary macroadenomas. Am J Otolaryngol 2021; 42:102808. [PMID: 33161260 DOI: 10.1016/j.amjoto.2020.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In pituitary macroadenomas with extensive suprasellar extension (SSE), suprasellar region can be approached by extending exposure either anteriorly by adding bone removal of the tuberculum sellae and planum sphenoidal or posteriorly from inside the sellar cavity through diaphragma sella. The later approach has been rapidly regressed in favor of the anteriorly extended approach, mainly due to the inadequate angled illumination. Benefiting from the continuous evolution of visualization, authors, in current series, tried to revive this technique in form of pure endoscopic trans-sellar trans-diaphragmatic approach (ETSDA) for extra-capsular resection of pituitary macroadenomas with extensive SSE. METHODS A prospective review including 10 patients of pituitary macroadenomas with extensive SSE more than 10 mm underwent extra-capsular resection via the ETSDA. The detailed technical nuances and surgical outcome of this approach were evaluated. RESULTS Six of 10 patients had SSE > 10 mm and 4 patients had SSE > 20 mm, grade B and C, respectively. Gross total resection was achieved in all cases. Postoperatively, visual field deficit was ameliorated to varying degrees in all patients. There were no serious intraoperative complications, and the clinically overt postoperative CSF rhinorrhea was not observed in any case. CONCLUSION Extra-capsular resection of pituitary macroadenomas with extensive SSE can be effectively and safely achieved using the ETSDA. Thus, it may be more preferable to the anteriorly extended approach that may potentially increase the risk for postoperative CSF rhinorrhea.
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Affiliation(s)
- Mostafa Ismail
- Department of Otorhinolaryngology, Minia University Hospital, Minia University, Egypt.
| | - Waleed Zidan
- Department of Neurosurgery, Minia University Hospital, Minia University, Egypt
| | - Khalaf Hamead
- Department of Otorhinolaryngology, Minia University Hospital, Minia University, Egypt
| | - Balegh Abdelhak
- Department of Otorhinolaryngology, Minia University Hospital, Minia University, Egypt
| | - Mohab Darwish
- Department of Neurosurgery, Minia University Hospital, Minia University, Egypt.
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Foran SJ, Laperriere N, Edelstein K, Janzen L, Tadic T, Ramaswamy V, Shultz D, Gentili F, Bouffet E, Tsang DS. Reirradiation for recurrent craniopharyngioma. Adv Radiat Oncol 2020; 5:1305-1310. [PMID: 33305092 PMCID: PMC7718531 DOI: 10.1016/j.adro.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Reirradiation is rarely administered to patients with recurrent craniopharyngioma owing to concerns regarding visual and endocrine side effects. The purpose of this case series was to evaluate our institutional experience of patients with craniopharyngioma treated with 2 courses of fractionated radiation therapy. Methods and Materials A retrospective study was performed of all patients with craniopharyngioma treated with 2 courses of fractionated radiation therapy at a single institution. Electronic medical records and radiation therapy records were reviewed. Results We identified 4 eligible patients with recurrent craniopharyngioma. With a median follow-up of 33 months after reirradiation, 3 patients attained disease control; 1 patient developed progressive disease, 27 months after reirradiation. In 3 evaluable patients, vision remained stable or improved after reirradiation; one patient had no light perception before reirradiation. None of the patients experienced additional endocrine toxicities after reirradiation, apart from one patient who had low serum thyroid stimulating hormone before reirradiation and later developed hypothyroidism after treatment. Conclusions Reirradiation may represent a safe and effective therapeutic option for selected patients with recurrent, refractory craniopharyngioma and without other salvage treatment options. Larger studies with longer-term follow up are warranted to better understand outcomes in these patients.
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Affiliation(s)
- Sarah J Foran
- University of Toronto, Faculty of Medicine, Toronto, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Kim Edelstein
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Laura Janzen
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Fred Gentili
- Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
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Characteristics of ectopic recurrence of craniopharyngioma: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Simonin A, Bangash O, Henley D, Bala A. Endonasal endoscopic resection of suprasellar craniopharyngioma: A retrospective single-center case series. J Clin Neurosci 2020; 81:436-441. [PMID: 33222959 DOI: 10.1016/j.jocn.2020.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/20/2020] [Accepted: 07/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Endoscopic endonasal approach (EEA) has recently been proposed as an option for resection of primary and recurrent suprasellar craniopharyngioma. However, surgical outcome has not yet been fully evaluated, especially in regards to recurrent cases. METHODS We analysed our institution (Sir Charles Gairdner University Hospital, Perth, Australia) case-series retrospectively. There were 16 patients operated through an endonasal endoscopic approach from February 2014 to February 2019 for suprasellar craniopharyngiomas. There were 14 primary, and two recurrent lesions. Extent of resection, complications, visual and endocrinological outcomes are presented. RESULTS Mean age of the patients was 42.9 ± 19.3 years old, with 56% female. The most common clinical symptoms were headaches (9 patients, 56%) and bi-temporal hemianopsia (9 patients, 56%), followed by unilateral optic neuropathy (5 cases, 31%), memory loss (1 case, 6%), hydrocephalus (1 case, 6%), delayed growth and puberty (1 case, 6%), and secondary amenorrhoea (1 case, 6%). Only two cases (12%) initially presented with normal visual function. Gross total resection (GTR) was achieved in 10/16 patients (62.5%), with subtotal resection (STR) in the remainder. Visual symptoms improved in 13/16 patients (81%) and remained unchanged in 3/16 patients (19%). Most common complications included new endocrinological deficit in nine patients (56%), mostly diabetes insipidus, and cerebrospinal fluid leak requiring a new intervention in three patients (19%). There was one mortality case (complicated meningitis, stroke and vasospasm). Mean follow-up time was 22.05 ± 14 months and three patients (19%) had a recurrence of the disease during this period and were referred for radiation therapy. CONCLUSION Endonasal endoscopic approach is a safe and effective surgical option for both primary and recurrent suprasellar craniopharyngiomas.
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Affiliation(s)
- Alexandre Simonin
- Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia.
| | - Omar Bangash
- Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
| | - David Henley
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Arul Bala
- Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia
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Alhoobi MMM, Khan A, Abu-Qadous FF, Kockro R, Hammadi F, Jarir RA, Belkhair S, Ayyad A. Translamina Terminalis Approach to the Hypothalamus Using Supraorbital Craniotomy: Technical Note and Comparison with Other Surgical Corridors. Asian J Neurosurg 2020; 15:660-665. [PMID: 33145223 PMCID: PMC7591184 DOI: 10.4103/ajns.ajns_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/14/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Approaches to the hypothalamus and anterior third ventricle are variable. We present a technical note on access of the hypothalamus using the trans-lamina terminalis approach by supraorbital craniotomy in a patient who had a hypothalamic cavernoma and presented to us with recurrent hemorrhage. Patients and methods The trans-lamina terminalis approach, including anatomical landmarks and surgical steps through a supra-orbital craniotomy, is described and a comparison with other surgical corridors is discussed. Results The supraorbital trans lamina terminalis approach allowed an effective access to the hypothalamic lesions. This approach provided a safe and minimally invasive corridor for gross total resection of the lesion since trespass of viable brain tissue is avoided. One clinical case illustrates the feasibility of the approach allowing complete removal of a cavernoma without surgery related neurological of endocrinological deficits. Conclusions The supra-orbital craniotomy for trans-lamina terminalis approach is a valid surgical choice for hypothalamic lesions. The major strengths of this approach include minimal brain retraction and direct end-on view; however, the long and narrow surgical corridor requires some technical familiarization. The clinical outcomes are comparable to other surgical corridors.
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Affiliation(s)
| | - Adnan Khan
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ralf Kockro
- Department of Neurosurgery, Hirslanden Klinik, Zurich, Switzerland
| | - Firas Hammadi
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Raed Abu Jarir
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Sirajeddin Belkhair
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Michigan State University, Lansing, US
| | - Ali Ayyad
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar.,Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Prediction of CTNNB1 Mutation Status in Pediatric Cystic Adamantinomatous Craniopharyngioma by Using Preoperative Magnetic Resonance Imaging Manifestation. Clin Neurol Neurosurg 2020; 200:106347. [PMID: 33160718 DOI: 10.1016/j.clineuro.2020.106347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE CTNNB1-targeted inhibitor is demonstrated to be an effective neoadjuvant therapy in adamantinomatous craniopharyngioma (ACP) patients and cystic degeneration is a canonical sign of pediatric ACP. This study aimed to investigate the relationship between the cystic performances and CTNNB1 mutation (CTNNB1 MUT) status so as to analyze the possible diagnostic criteria of CTNNB1 MUT in pediatric cystic ACP (PCACP). METHODS Patient's population, clinical characteristics, tissue samples and MRI data were collected and summarized in PCACP patients. The results were compared between CTNNB1 MUT and CTNNB1 wild-type (WT) groups according to the Sanger sequencing. MRI features of the cyst were also recorded. The receiving operating characteristic (ROC) curve analysis was applied to evaluate the differential diagnostic value. RESULTS 19 of the 61 patients manifested CTNNB1 MUT PCACP and 42 patients were CTNNB1 WT PCACP. Multiple cysts, irregular shape of cyst, hypo-intense interior signal of cyst on non-contrast T1W1, compression with optic chiasm and pituitary stalk and enhancement signal of cystic wall have been demonstrated in CTNNB1 MUT PCACP patients on MRI. Only the Area under the curve (AUC) values of quantity of cyst, shape of cyst and interior signal of cyst on non-contrast T1W1 were over 0.7. For criteria based on the combination of the 6 characteristic features, the AUC value was 0.928. CONCLUSION Preoperative MRI may provide an effective value in predicting PCACP patients with CTNNB1 MUT and offer potential evidence for preoperative management with molecular targeted agents.
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Sadhasivam S, Menon G, Abraham M, Nair SN. The implication of giant tumor size on surgical resection, oncological, and functional outcomes in craniopharyngioma. Pituitary 2020; 23:515-525. [PMID: 32451987 DOI: 10.1007/s11102-020-01053-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Implication of the tumor size on oncological and functional outcomes of craniopharyngioma is inconsistently reported. The aim of this study is to assess the postoperative outcome of giant craniopharyngiomas (> 4 cm in diameter) and to elucidate the impact of tumor size on various outcome parameters and survival. MATERIAL AND METHODS Forty-four patients (children aged ≤ 18 years: 25; adults: 16) with giant craniopharyngioma, operated between January 2001 and December 2015, were included in this study. Various outcomes, progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Gross total resection (GTR) was achieved in 17 (39%) and subtotal resection (STR) in 27 (61%) patients. Eleven patients (25%) received radiotherapy (RT) after STR. Postoperatively, new cranial nerve and motor deficits were noted in 12 (27%) and 9 (20%) patients, respectively. Tumor recurrence following GTR and STR without adjuvant RT was diagnosed in 3 (17%), and 5 (38%) patients, respectively. Following STR with RT, one (9%) experienced recurrence. PFS at 5-, and 10- year following GTR, STR, and STR + RT was 80.8%, 45.4%, and 90%, respectively. At 5- and 10- year, OS was 86.5%, 77.9% and 100% following GTR, STR, and STR + RT, respectively. The rate of GTR was significantly lower in patients with giant tumors (39% vs. 62%; Chi-square test, p value 0.008). Postoperatively, neurological deficit (20%), hypopituitarism (95%) and hypothalamic dysfunction (26%) were significantly higher for giant craniopharyngiomas. Hazards of recurrence were not significant between giant and non-giant tumors (hazard ratio 1.86; 95% CI 0.94-3.68; p 0.07). There was no significant difference in OS between the patients with giant and non-giant tumors (log-rank test 2.1; p value 0.14). CONCLUSION Tumor size should be considered as an important predictor of the postoperative functional outcome. Although the rate of GTR is less than that of small tumors, the recurrence rate, progression-free survival, and overall survival of the patients with giant tumor are comparable to non-giant tumors.
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Affiliation(s)
- Saravanan Sadhasivam
- Department of Neurosurgery, All India Institute of Medical Science, Veerbhadra Road, Rishikesh, Uttarakhand, 249203, India.
| | - Girish Menon
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Suresh Narayanan Nair
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
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Jugović D, Spazzapan P, Porčnik A, Prestor B. TRANS-ENDOSCOPIC TREATMENT OF CRANIOPHARYNGIOMA AND RECOVERY FROM BLINDNESS IN ADULT PATIENT - A CASE REPORT. Acta Clin Croat 2020; 59:549-554. [PMID: 34177068 PMCID: PMC8212660 DOI: 10.20471/acc.2020.59.03.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a case of trans-endoscopic transventricular approach to a large cystic craniopharyngioma. Surgery was performed three days after visual acuity on both eyes deteriorated to blindness. Magnetic resonance imaging before surgery revealed a large lesion in the suprasellar region that severely compressed the optic chiasm and displaced the third ventricle upward. The lesion was operated through the trans-endoscopic transventricular approach, with the aim of urgent decompression of the optic apparatus. At first, wide ventriculo-cysto-cisternostomy was performed, and then tumor tissue was removed. Postoperatively, visual acuity significantly improved on one eye. Our case shows that this minimally invasive technique is safe and effective and can be an alternative treatment for large cystic craniopharyngiomas. The reported case also shows that loss of vision can still be recovered even after the 72-hour period in adults.
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Affiliation(s)
| | - Peter Spazzapan
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Porčnik
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Prestor
- 1Department of Neurosurgery, Bamberg General Hospital, Bamberg, Germany; 2University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia; 3Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Xiao G, Yuan X, Yuan J, Li Y, Chen X. Intracranial fusiform aneurysm following microsurgery for adult craniopharyngioma: Clinical experience and review of literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lei C, Chuzhong L, Chunhui L, Peng Z, Jiwei B, Xinsheng W, Yazhuo Z, Songbai G. Approach selection and outcomes of craniopharyngioma resection: a single-institute study. Neurosurg Rev 2020; 44:1737-1746. [PMID: 32827306 DOI: 10.1007/s10143-020-01370-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/23/2020] [Accepted: 08/12/2020] [Indexed: 01/30/2023]
Abstract
Since there are many approaches for successful craniopharyngioma resection, how to choose a suitable approach remains problematic. The aim of this study was to summarize experience of approach selection and outcomes of craniopharyngioma resection in our institute. The data of 182 primary craniopharyngiomas between January 2013 and June 2019 were retrospectively reviewed. Craniopharyngiomas were classified into intrasellar, intra-suprasellar, suprasellar, and intra-third ventricle types based on the location. The surgical approaches, extent of resection, endocrine and ophthalmological outcomes, and complications were evaluated. Gross total resection (GTR) was achieved in 158 (86.8%) patients, near-total resection (NTR) in 20 (11%), and partial resection (PR) in 4 (2.2%). New-onset hypopituitarism occurred in 90 (49.5%) and new-onset diabetes insipidus in 48 (26.4%). Visual function was improved in 110 of the 182 patients, unchanged in 52, and deteriorated in 20. For intra-suprasellar and suprasellar tumors, patients in the endoscopic endonasal approach (EEA) group had higher GTR rate, lower incidence of new-onset hypopituitarism, and better visual outcome than patients in transcranial approach group, but no significant difference in the incidence of new-onset diabetes insipidus was found. There were no surgery-related deaths, and the common complications included permanent oculomotor nerve palsy, hemorrhage, and cerebrospinal fluid leaks. During the follow-up period, tumor recurrence or regrowth occurred in 6.6% of the cases. Tumor location is key for choosing an optimal surgical approach for craniopharyngioma resection. The EEA should be considered as the first choice for intra-suprasellar and suprasellar craniopharyngiomas to achieve better visual outcomes and fewer pituitary hormonal disorders.
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Affiliation(s)
- Cao Lei
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Li Chuzhong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Liu Chunhui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Zhao Peng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Bai Jiwei
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Wang Xinsheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Zhang Yazhuo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Gui Songbai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China.
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Burgess L, Chakraborty S, Malone S. Effective salvage of recurrent craniopharyngioma with fractionated stereotactic radiotherapy. Radiol Case Rep 2020; 15:1750-1755. [PMID: 32774574 PMCID: PMC7397706 DOI: 10.1016/j.radcr.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022] Open
Abstract
Craniopharyngiomas can invade surrounding structures, including the optic chiasm and hypothalamus. In such cases, subtotal resection is often preferred to limit perioperative morbidity and mortality; however, subtotal resection is associated with high rates of recurrence. Recurrent craniopharyngioma is typically treated with another subtotal resection and adjuvant radiotherapy. We present a case of a patient found to have a large craniopharyngioma compressing the optic chiasm, hypothalamus and left cavernous sinus. She underwent surgical debulking but developed recurrence shortly thereafter. Subsequently, she underwent a second debulking surgery, followed by fractionated stereotactic radiotherapy (SRT). Results show that she exhibited an impressive response to SRT with further tumor shrinkage, while remaining clinically well. This case demonstrates the efficacy of SRT in salvage of recurrent craniopharyngioma.
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Affiliation(s)
- Laura Burgess
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario K1H8L6, Canada
| | - Santanu Chakraborty
- Department of Radiology, University of Ottawa, Ottawa, Ontario, K1H8L6, Canada
| | - Shawn Malone
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario K1H8L6, Canada
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Prieto R, Rosdolsky M, Hofecker V, Barrios L, Pascual JM. Craniopharyngioma treatment: an updated summary of important clinicopathological concepts. Expert Rev Endocrinol Metab 2020; 15:261-282. [PMID: 32615875 DOI: 10.1080/17446651.2020.1770081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Craniopharyngiomas (CPs) are benign histological tumors that may develop at different positions along the hypothalamic-pituitary axis. Their close, heterogenous relationship to the hypothalamus makes surgical removal challenging even though this remains the primary treatment strategy. AREAS COVERED This article presents a critical overview of the pathological and clinical concepts regarding CPs that should be considered when planning treatment. Thus, we have performed a comprehensive review of detailed CP reports published between 1839 and 2020. EXPERT OPINION CP surgery should pursue maximal tumor resection while minimizing the risk of injuring the hypothalamus. Therefore, surgical strategies should be individualized for each patient. Accurate assessment of presenting symptoms and preoperative MRI has proven useful to predict the type of CP-hypothalamus relationship that will be found during surgery. CPs with dense and extensive adhesions to the hypothalamus should be highly suspected when MRI shows the hypothalamus positioned around the mid-third of the tumor and an amputated upper portion of the pituitary stalk. Symptoms related to functional impairment of the infundibulo-tuberal area of the third ventricle floor, such as obesity/hyperphagia, Fröhlich's syndrome, diabetes insipidus, and/or somnolence, also indicate risky CP-hypothalamic adhesions. In these cases, limited tumor removal is strongly advocated followed by radiation therapy.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital , Madrid, Spain
| | | | - Verena Hofecker
- Pathologisch-anatomische Sammlung Im Narrenturm - NHM , Vienna, Austria
| | - Laura Barrios
- Statistics Department, Computing Center, CSIC , Madrid, Spain
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital , Madrid, Spain
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Tang B, Xie S, Huang G, Wang Z, Yang L, Yang X, Xu S, Zeng E, Hong T. Clinical features and operative technique of transinfundibular craniopharyngioma. J Neurosurg 2020; 133:119-128. [PMID: 31200374 DOI: 10.3171/2019.3.jns181953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Transinfundibular craniopharyngioma (TC) is one of the 4 subtypes of suprasellar craniopharyngioma. In this study, the authors analyzed the clinical features of and operative technique for TC. METHODS A total of 95 consecutive cases of suprasellar craniopharyngioma that had been resected via the endoscopic expanded endonasal approach were retrospectively reviewed. Patients were divided into 2 groups: 34 in the TC group and 61 in the nontransinfundibular craniopharyngioma (NC) group. Clinical and radiographic features, intraoperative findings, histopathological and genetic findings, and surgical outcomes were analyzed and compared between groups. RESULTS Compared with NC, TC was mostly seen in adult patients (97.1%); it was rare in children (2.9%). Clinical presentations tended toward headache, hydrocephalus, and diabetes insipidus. The relatively smaller volume, midline location (consistent with the stalk position), unidentifiable stalk, no shift of the third ventricle, and greater likelihood to involve the third ventricle and cause hydrocephalus were the characteristic features of TC in the preoperative MRI study. According to the degree of vertical extension of the tumor, the 34 TCs could be classified into 3 subtypes: type 1, entity was limited to stalk (n = 2, 5.9%); type 2, tumor extended up to the third ventricle (type 2a) or down to the subdiaphragmatic cavity (type 2b) (n = 23, 67.6%); and type 3, tumor extended in both directions (n = 9, 26.5%). For TC resection, the chiasm-pituitary corridor, lamina terminalis corridor, and pituitary corridor could be used separately or jointly. Most of the TCs originated from the infundibulum-tuber cinereum, grew within and along the long axis of the infundibulum, and the pituitary stalk was not usually preserved in TCs (20.6%), whereas the rate of preservation was higher (80.3%) in NCs. Bilateral hypothalamic injury was found in nearly all TCs if radical resection was performed, whereas the relationship between NCs and hypothalamus was either compression (32.8%) or unilateral invasion (67.2%). Meanwhile, the postoperative endocrine and neuropsychological function outcomes in patients with TC were worse than in patients with NC. The genetic analysis with whole-exome sequencing studies showed no differential mutations of CTNNB1 (β-catenin) and BRAF (V600E) between TC and NC subtypes, but there was a difference between adamantinomatous craniopharyngioma and papillary craniopharyngioma. CONCLUSIONS TC is a special subtype of suprasellar craniopharyngioma, which is remarkably different from NC. Identification of this type of tumor preoperatively is essential for the planning of appropriate surgical approach and degree of excision.
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Affiliation(s)
| | | | | | | | - Le Yang
- Departments of1Neurosurgery and
| | | | - Shan Xu
- 2Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
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Eveslage M, Calaminus G, Warmuth-Metz M, Kortmann RD, Pohl F, Timmermann B, Schuhmann MU, Flitsch J, Faldum A, Müller HL. The Postopera tive Quality of Life in Children and Adolescents with Craniopharyngioma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:321-328. [PMID: 31219033 DOI: 10.3238/arztebl.2019.0321] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/09/2018] [Accepted: 03/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Craniopharyngioma is a tumor of low histological malignancy resulting from an anomaly of embryonic development. Affected children and adolescents are being studied with respect to their quality of life, progression-free survival, and overall survival in the framework of the ongoing KRANIOPHARYNGEOM 2007 project. METHODS This prospective, multicenter project consists of a randomized trial with an adaptive design combined with a purely observational study. The randomized, unblinded trial includes patients whose tumors have been incompletely resected and is intended to compare the outcomes of immediate postoperative radiotherapy versus radiotherapy on progression. Its primary endpoint is quality of life as assessed subjectively by the patients them- selves with the "Pediatric Quality of Life" questionnaire (PEDQOL). In exploratory analyses, linear mixed models were used to study the effect of further factors on quality of life. RESULTS An interim intention-to-treat analysis of the randomized trial revealed only minor differences between the treatment arms with respect to quality of life (n = 24). The exploratory analyses (n = 131) showed that preoperative involvement of, or operative damage to, the anterior and posterior regions of the hypothalamus was associated with a lower quality of life. Complete resection was followed by a lower quality of life than incomplete resection. Radiotherapy, a common treatment for tumors that progress after incomplete resection, was also associated with a lower quality of life. CONCLUSION Hypothalamus-sparing treatment approaches are recommended to optimize the quality of life of children and adolescents with cranio- pharyngioma. The available evidence does not support any recommendation as to when radiotherapy should be performed after incomplete resection so that the best quality of life can be achieved.
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Affiliation(s)
- Maria Eveslage
- Institute of Biostatistics and Clinical Research, Universtity of Münster; Department of Pediatric Hematology/Oncology, University Children's Hospital Bonn; Department of Interventional and Diagnostic Neuroradiology, Universitiy Hospital Würzburg; Department of Radiation Oncology, University of Leipzig; Department of Radiotherapy, University Hospital Regensburg; Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE); Division of Pediatric Neurosurgery within the Department of Neurosurgery, University Hospital Tübingen; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf (UKE); Institute of Biostatistics and Clinical Research, Universtity of Münster; Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Oldenburg
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Massa D, Glerean M, Rasmussen J, Altszul M, Fainstein-Day P, Ajler P. Craniopharyngiomas: experience and results. Neurocirugia (Astur) 2020; 32:105-113. [PMID: 32446620 DOI: 10.1016/j.neucir.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Craniopharyngiomas are a big challenge in the neurosurgical field. Because these lesions involve important systems, surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. We present the outcomes of our patients based on clinical results, degree of resection, recurrence and disease-free survival. MATERIALS AND METHODS We reviewed medical records in all patients who had undergone surgical resection for craniopharyngioma at (Hospital Italiano de Buenos Aires) between 2007 and 2019. We considered ophthalmological examinations, imaging studies, endocrinological studies and surgical complications. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor location. RESULTS Thirty cases of craniopharyngioma were analysed. 12.5% were classified as intrasellar, 12.5% as prechiasmatic, 43.75% as retrochiasmatic, and 31.25% as intraventricular. Overall, 38 cases involved a transcranial surgery (15 orbitozygomatic approach; 19 pterional approach and 4 transcallosal approach), seven involved a transsphenoidal approach, two microscopic transnasal approach and one ventricular endoscopy for emptying the craniopharyngioma cyst. Gross-total resection was achieved in 43.7% and near-total resection (more than 90%) in 25%. The mean follow-up period after resection was 4.7 years. Tumor recurrence occurred in 48%, with an average of 42.7 disease-free months. CONCLUSION Total tumor resection is the best treatment for craniopharyngioma. Due to its high morbidity and mortality, a multidisciplinary team is necessary for the management of these tumors.
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Affiliation(s)
- D Massa
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina.
| | - M Glerean
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Argentina
| | - J Rasmussen
- Servicio de Neurocirugía, Hospital Español, Mendoza, Argentina
| | - M Altszul
- Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina
| | - P Fainstein-Day
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Argentina
| | - P Ajler
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:1159-1177. [PMID: 32112169 DOI: 10.1007/s00701-020-04265-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
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.
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Giese H, Haenig B, Haenig A, Unterberg A, Zweckberger K. Neurological and neuropsychological outcome after resection of craniopharyngiomas. J Neurosurg 2020; 132:1425-1434. [PMID: 31003210 DOI: 10.3171/2018.10.jns181557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Craniopharyngiomas are rare and benign tumors of the sellar and/or parasellar region. Primary treatment involves resection followed by adjuvant radiotherapy. While the grade of resection was frequently analyzed following surgery, the neurological outcome and especially neuropsychological deficits and quality of life have been neglected for many decades. Therefore, the authors retrospectively analyzed their patient series and prospectively assessed neuropsychological outcome and quality of life following resection of craniopharyngiomas in adults. METHODS In total, 71 patients (39 men and 32 women) with a mean age of 49 years were enrolled in the retrospective analysis. In addition, 36 of the 71 patients were included in the prospective arm of the study and underwent neurological and neuropsychological testing as well as quality of life (36-Item Short-Form Health Survey; SF-36) assessment. Factors influencing outcome were identified and correlations calculated. RESULTS Resection was performed mostly using a pterional (41.6%, 47/113 surgical procedures) or bifrontal translamina terminalis (30.1%, 34/113 surgical procedures) approach. Following surgery, visual acuity was significantly improved (> 0.2 diopters) in 32.4% (23/71) of patients, or remained stable in 45.1% (32/71) of patients. During long-term follow up, 80.3% (57/71) of patients developed pituitary insufficiency, particularly involving the corticotropic and thyrotrophic axes. In total, 75% (27/36) of patients showed neuropsychological deviations in at least 1 test item. In particular, attentiveness, cognitive speed, and short-term memory were affected. Referring to the SF-36 score, quality of life was affected in both the mental and physical score in 19.4% (7/36) and 33.3% (12/36), respectively. The risk factors that were identified were a tumor volume larger than 9 cm3, tumor extension toward/into the third ventricle or the brainstem, and resection using a bifrontal translamina terminalis or left-sided approach. CONCLUSIONS This study demonstrated that resection of craniopharyngiomas is frequently associated with postoperative neuropsychological deficits and hence an impaired quality of life. In addition to tumor size and extension toward/into the third ventricle or the brainstem, selection of the surgical approach may play a crucial role in the patient's neuropsychological outcome and quality of life.
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Gupta N. Editorial. Patient outcomes following treatment for craniopharyngioma. J Neurosurg 2020; 132:1423-1424. [PMID: 31003216 DOI: 10.3171/2018.12.jns182943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tsugawa T, Kobayashi T, Hasegawa T, Iwai Y, Matsunaga S, Yamamoto M, Hayashi M, Kenai H, Kano T, Mori H, Nagano O, Hasegawa S, Inoue A, Nagatomo Y, Onoue S, Sato M, Yasuda S. Gamma Knife Surgery for Residual or Recurrent Craniopharyngioma After Surgical Resection: A Multi-institutional Retrospective Study in Japan. Cureus 2020; 12:e6973. [PMID: 32201653 PMCID: PMC7075476 DOI: 10.7759/cureus.6973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective The optimal treatment for a craniopharyngioma has been controversial. Complete resection is ideal, but it has been difficult to obtain total resection in many cases because of intimate proximity to critical structures such as the optic pathway, hypothalamus, and pituitary gland. A growing number of studies have demonstrated the utility of radiosurgery in controlling residual or recurrent craniopharyngioma. However, most of them are small series. The aim of this multi-institutional study was to clarify the efficacy and safety of Gamma Knife (Elekta, Stockholm, Sweden) surgery for patients with a craniopharyngioma. Methods This was a multi-institutional retrospective study by 16 medical centers of the Japan Leksell Gamma Knife Society. Data on patients with craniopharyngiomas treated with Gamma Knife Surgery (GKS) between 1991 and 2013 were obtained from individual institutional review board-approved databases at each center. A total of 242 patients with craniopharyngioma were included in this study. The mean age of the patients was 41 (range, 3 to 86) years. The median follow-up time was 61.4 months (range, 3 to 180 months). The mean radiosurgery target volume was 3.1 ml (range, 0.03-22.3 ml), and the mean marginal dose was 11.4 Gy (range, 8-20.4 Gy). Results Two-hundred twenty patients were alive at the time of the last follow-up visit. The three-, five-, and 10-year overall survival rates after GKS were 95.4%, 92.5%, and 82.0%, respectively. The three-, five-, and 10-year progression-free survival rates after GKS were 73.1%, 62.2%, and 42.6% respectively. The rate of radiation-induced complications was 6.2%. Conclusion GKS is effective for controlling the tumor growth of craniopharyngiomas with an acceptable complication rate.
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Affiliation(s)
- Takahiko Tsugawa
- Neurosurgery, Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, JPN
| | - Tatsuya Kobayashi
- Neurosurgery, Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, JPN
| | | | | | | | - Masaaki Yamamoto
- Neurosurgery, Mito Gammahouse, Katsuta Hospital, Hitachinaka, JPN
| | - Motohiro Hayashi
- Neurosurgery, Tokyo Women's Medical University Hospital, Tokyo, JPN
| | - Hiroyuki Kenai
- Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, JPN
| | | | - Hisae Mori
- Neurosurgery, National Cerebral and Cardiovascular Center, Suita, JPN
| | - Osamu Nagano
- Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara, JPN
| | | | - Akira Inoue
- Neurosurgery, Yamagata Prefectural Central Hospital, Yamagata, JPN
| | | | - Shinji Onoue
- Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, JPN
| | - Manabu Sato
- Neurosurgery, Rakusai Shimizu Hospital, Kyoto, JPN
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Adult craniopharyngioma: The role of extent of resection in tumor recurrence and long-term functional outcome. Clin Neurol Neurosurg 2020; 192:105711. [PMID: 32036264 DOI: 10.1016/j.clineuro.2020.105711] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/25/2019] [Accepted: 02/02/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The optimal therapeutic approach to craniopharyngioma has not been established conclusively. The surgical outcome following radical excision and conservative resection with adjuvant radiotherapy are comparable or even better with the later in pediatric or mixed populations. This study is aimed at reviewing the role of extent of resection in local tumor control and long-term outcome in adults with craniopharyngioma. PATIENTS AND METHODS Ninety-five adults operated between 2001 and 2013 were included. Progression-free survival (PFS) and overall survival (OS) were calculated. Predictors of various outcome parameters were analyzed. RESULTS The predominant presenting symptom was visual impairment (78 %) followed by symptoms of hypothalamic involvement (29 %). Total and subtotal excisions (TE, STE) were achieved in 63 %, and 47 % of patients, respectively. Vision improved in 62 % of patients in the early postoperative period. Thirteen patients (14 %) experienced vision deterioration postoperatively. On multivariate analysis, tumor >3 cm and optic atrophy predicted poor visual outcome. Hormonal replacement for hypopituitarism was required in 83 % during follow-up. Diabetes insipidus was seen in 73 %. Imaging evidence of 3rd ventricular floor destruction by tumor emerged as an independent predictor of postoperative hypothalamic morbidities. The recurrence rate following TE and STE was 11.6 % and 72 %, respectively. Unlike radical excision, PFS following STE was significantly shorter (p- 0.02). TE was not associated with increased visual impairment or hypothalamic-pituitary dysfunction postoperatively as compared to STE. Most of the patients (85 %) were independent and able to return to the premorbid occupation. CONCLUSION Subtotal resection provides equally good long-term visual, endocrinological, and hypothalamic outcomes as radical surgery. When used with adjuvant radiotherapy, it also gives a better local control of the tumor. Hence, subtotal resection with adjuvant radiotherapy should be considered as an effective alternative strategy to radical excision.
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Al Shail E, Al-Shenkiti A, Alotaibi MT, Siddiqui K, Al-Kofide A. Excision of pediatric craniopharyngioma: pattern of recurrence in 35 patients at a tertiary care hospital in Saudi Arabia. Childs Nerv Syst 2020; 36:297-304. [PMID: 31482312 DOI: 10.1007/s00381-019-04349-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Craniopharyngiomas are benign tumors of central nervous system which are known to affect both adults and children. Despite their benign origin, the recurrence is still one of the main postoperative challenges. The aim of this study was to investigate in retrospect factors related to recurrence of craniopharyngioma in a tertiary center in Riyadh, Saudi Arabia. PATIENTS AND METHODS We conducted a review of charts of all craniopharyngioma patients operated in neurosurgery department at King Faisal Specialist Hospital & Research Center in Riyadh (KFSH-RC). Age at surgery, gender, body mass index, symptoms at presentation, hormonal data, tumor characteristics and location, presence of hydrocephalus, previous treatments, neuroimaging features, surgical results, and recurrence were abstracted from the medical charts of the patients retrospectively. RESULTS In all, 70.6% of patients had gross total resection (GTR). The recurrence after GTR in our series was 25% which considered low when compared to most surgical series. From all above studied variables, VP shunt insertion at presentation was constantly significant in both uni- and multi-variable analysis. CONCLUSION In this study, we analyzed several factors to determine if they had any significant correlation with recurrence. Only VP shunt insertion was found significant. Further researches are needed to verify these factors and to discover others.
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Affiliation(s)
- Essam Al Shail
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia.
| | - Ahmad Al-Shenkiti
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | | | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Amani Al-Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
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Albano L, Losa M, Flickinger J, Mortini P, Minniti G. Radiotherapy of Parasellar Tumours. Neuroendocrinology 2020; 110:848-858. [PMID: 32126559 DOI: 10.1159/000506902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects.
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Affiliation(s)
- Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
- UPMC Hillman Cancer Center San Pietro Hospital, Rome, Italy,
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Ciurea A, Saceleanu V, Mohan A, Moreanu M, Toader C. Craniopharyngiomas in children - experience of consecutive 152 operated cases. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2020; 16:103-109. [PMID: 32685048 PMCID: PMC7363995 DOI: 10.4183/aeb.2020.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors. OBJECTIVE This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases. DESIGN This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest. SUBJECTS AND METHODS 152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease. RESULTS Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%). CONCLUSIONS Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.
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Affiliation(s)
- A.V. Ciurea
- “Carol Davila” University School of Medicine - Department of Neurosurgery
| | - V. Saceleanu
- “Lucian Blaga” University of Sibiu, Faculty of Medicine - Department of Neurosurgery
- Sibiu County Emergency Hospital - Department of Neurosurgery, Sibiu
| | - A. Mohan
- University of Oradea, Faculty of Medicine and Pharmacy - Department of Surgical Disciplines
- Bihor County Emergency Hospital - Department of Neurosurgery, Oradea, Romania
| | - M.S. Moreanu
- “Carol Davila” University School of Medicine - Department of Neurosurgery
| | - C. Toader
- “Carol Davila” University School of Medicine - Department of Neurosurgery
- National Institute of Neurology and Neurovascular Diseases - Department of Neurosurgery, Bucharest
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Cabuk B, Anik I, Kokturk S, Ceylan S, Ceylan S. Anatomic and histologic features of diaphragma sellae that effects the suprasellar extension. J Clin Neurosci 2019; 71:234-244. [PMID: 31843433 DOI: 10.1016/j.jocn.2019.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/16/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
This study aimed to determine the anatomical and histological features of diaphragma sellae that affect the suprasellar extension of intrasellar tumours. Twenty-four fresh adult cadavers were dissected for the study. Diaphragma sellae and pituitary capsules with sellar structures were resected. The diaphragma sellae was anatomically reviewed in detail. Immunohistochemical staining was performed for collagen types I, II, III, and IV. We examined the suprasellar growth of 13 sellar tumours extending superiorly through the diaphragma sellae by performing a series of 2704 endoscopic transnasal operations to analyse the anatomic and histologic results of the study. The diameter of the foramen of diaphragma sellae varied between specimens. Of 24 specimens, the diaphragma sellae in five (21%) had a tight-type foramen and those in 19 (79%) were more spacious. An increased expression of collagen types I and IV was observed in the pituitary capsule and the diaphragma sellae. In this clinical series, we observed that all types of sellar tumours could expand through the foramen. We observed radiologically and intraoperatively that the diaphragma sellae was displaced laterally and formed a dome in two cases with an adenoma extending to the suprasellar area. Two types of suprasellar extension through the diaphragma sellae are possible: 1) The collagen structure of diaphragma sellae can be destroyed by invasive tumours; 2) The morphology of the foramen of the diaphragma sellae facilitates suprasellar tumoural extension. All sellar tumours, including non-invasive cystic tumours, may invade the suprasellar area by expanding through the foramen of the diaphragma sellae.
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Affiliation(s)
- Burak Cabuk
- Kocaeli University, School of Medicine, Department of Neurosurgery and Kocaeli University, Pituitary Research Center, Kocaeli, Turkey
| | - Ihsan Anik
- Kocaeli University, School of Medicine, Department of Neurosurgery and Kocaeli University, Pituitary Research Center, Kocaeli, Turkey
| | - Sibel Kokturk
- Ordu University, School of Medicine, Department of Histology, Ordu, Turkey
| | - Sureyya Ceylan
- Kocaeli University, School of Medicine, Department of Histology, Kocaeli, Turkey
| | - Savas Ceylan
- Kocaeli University, School of Medicine, Department of Neurosurgery and Kocaeli University, Pituitary Research Center, Kocaeli, Turkey.
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Abstract
Craniopharyngiomas are rare malformational tumours of low histological malignancy arising along the craniopharyngeal duct. The two histological subtypes, adamantinomatous craniopharyngioma (ACP) and papillary craniopharyngioma (PCP), differ in genesis and age distribution. ACPs are diagnosed with a bimodal peak of incidence (5-15 years and 45-60 years), whereas PCPs are restricted to adults mainly in the fifth and sixth decades of life. ACPs are driven by somatic mutations in CTNNB1 (encoding β-catenin) that affect β-catenin stability and are predominantly cystic in appearance. PCPs frequently harbour somatic BRAFV600E mutations and are typically solid tumours. Clinical manifestations due to increased intracranial pressure, visual impairment and endocrine deficiencies should prompt imaging investigations, preferentially MRI. Treatment comprises neurosurgery and radiotherapy; intracystic chemotherapy is used in monocystic ACP. Although long-term survival is high, quality of life and neuropsychological function are frequently impaired due to the close anatomical proximity to the optic chiasm, hypothalamus and pituitary gland. Indeed, hypothalamic involvement and treatment-related hypothalamic lesions frequently result in hypothalamic obesity, physical fatigue and psychosocial deficits. Given the rarity of these tumours, efforts to optimize infrastructure and international collaboration should be research priorities.
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Affiliation(s)
- Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany.
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Juan-Pedro Martinez-Barbera
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stephanie Puget
- Service de Neurochirurgie, Hôpital Necker-Enfants Malades, Sorbonne Paris Cité, Paris, France
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Drapeau A, Walz PC, Eide JG, Rugino AJ, Shaikhouni A, Mohyeldin A, Carrau RL, Prevedello DM. Pediatric craniopharyngioma. Childs Nerv Syst 2019; 35:2133-2145. [PMID: 31385085 DOI: 10.1007/s00381-019-04300-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Craniopharyngioma has historically been recognized to be a formidable pathology primarily due to its proximity to critical neurovascular structures and the challenging surgical corridors that surgeons have tried to reach this lesion. FOCUS OF REVIEW In this work, we review the medical and surgical management of these tumors with a focus on clinical presentation, diagnostic identification, surgical approach, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to craniopharyngiomas. The management of craniopharyngiomas requires a multidisciplinary team of surgeons, endocrinologists, and neuroanesthesiologists as well as neurocritical care specialists to deliver the most comprehensive and safest surgical resection with minimal postoperative morbidity.
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Affiliation(s)
- Annie Drapeau
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick C Walz
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, USA. .,Department of Pediatric Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, 43205, OH, USA.
| | - Jacob G Eide
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ammar Shaikhouni
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmed Mohyeldin
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Daniel M Prevedello
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, USA
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83
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Koumas C, Laibangyang A, Barron SL, Mittler MA, Schneider SJ, Rodgers SD. Outcomes following endoscopic endonasal resection of sellar and supresellar lesions in pediatric patients. Childs Nerv Syst 2019; 35:2099-2105. [PMID: 31214816 DOI: 10.1007/s00381-019-04258-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The endoscopic endonasal approach (EEA) is a credible surgical alternative for the resection of sellar and suprasellar lesions such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. However, its application to pediatric patients poses several unique challenges that have not yet been well evaluated. The authors evaluate the safety, efficacy, and outcomes associated with the use of the EEA for treatment of these pathologic entities in pediatric patients. METHODS Retrospective review of 30 patients between the ages of two and 24 who underwent endoscopic endonasal resection of sellar or suprasellar lesions between January 2010 and December 2015. Endocrinological and ophthalmological outcomes, as well as extent of resection and complications were all evaluated. RESULTS Gross total resection was achieved in eight of the nine pituitary adenomas, nine of the 12 craniopharyngiomas, and six of the nine Rathke cleft cysts. Of the 30 patients, 22 remained disease free at last follow-up. A total of six patients developed hypopituitarism and five developed diabetes insipidus. Eleven patients experienced improved vision, sixteen experienced no change, and one patient experienced visual worsening. Postoperative cerebrospinal fluid leak was seen in a single case and later resolved, vasospasm/stroke was experienced by 10% of patients, and new obesity was recorded in 10% of patients. There were no perioperative deaths. CONCLUSIONS Endoscopic endonasal resection is a safe and effective surgical alternative for the management of sellar and suprasellar pathologies in pediatric populations with excellent outcomes, minimal complications, and a low risk of morbidity.
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Affiliation(s)
- Christoforos Koumas
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anya Laibangyang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Shanna L Barron
- Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Mark A Mittler
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Steven J Schneider
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA
| | - Shaun D Rodgers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. .,Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA.
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Boekhoff S, Bison B, Eveslage M, Sowithayasakul P, Müller HL. Craniopharyngiomas presenting as incidentalomas: results of KRANIOPHARYNGEOM 2007. Pituitary 2019; 22:532-541. [PMID: 31440945 DOI: 10.1007/s11102-019-00983-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Childhood-onset craniopharyngiomas (CP) are diagnosed due to clinical symptoms (symCP) or incidentally (incCP). We investigated clinical manifestations and outcome in incCPs and symCPs. METHODS IncCP were discovered in 4 (3 m/1 f) and symCP in 214 (101 m/113 f) CP recruited 2007-2014 in KRANIOPHARYNGEOM 2007. Age, sex, height, body mass index (BMI), tumor volume, degree of resection, pre- and postsurgical hypothalamic involvement/lesions, pituitary function and outcome were compared between both subgroups. RESULTS Reasons for imaging in incCP were cerebral palsy, head trauma, nasal obstruction, and tethered-cord syndrome, whereas headache (44%), visual impairment (25%), and growth retardation (17%) lead to imaging in symCP. Tumor volume at diagnosis was smaller in incCP (median 2.39 cm3; range 0.14-4.10 cm3) when compared with symCP (15.86 cm3; 0.002-286.34 cm3). Age, gender, BMI, height, hydrocephalus, tumor location, and hypothalamic involvement at diagnosis of incCP were within the range of these parameters in symCP. Complete resections were achieved more frequently (3/4 patients) in incCP when compared with symCP (20%). Surgical hypothalamic lesions were distributed similar in incCP and symCP. Irradiation was performed only in symCP (33%). No noticeable differences were observed concerning survival rates, endocrine deficiencies, BMI, height, functional capacity and quality of life of the 4 incCP cases when compared with the symCP cohort. CONCLUSIONS IncCP are rare (1.8%) and characterized by lack of endocrine deficiencies, resulting in normal height and BMI, no hydrocephalus, and smaller tumor volume at diagnosis when compared with symCPs. Outcome of the observed incCP is similar with symCP. CLINICAL TRIAL REGISTRATION NUMBER NCT01272622.
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Affiliation(s)
- Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Würzburg, 97080, Würzburg, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, 48149, Münster, Germany
| | - Panjarat Sowithayasakul
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, 26120, Bangkok, Thailand
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany.
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85
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Ordóñez-Rubiano EG, Forbes JA, Morgenstern PF, Arko L, Dobri GA, Greenfield JP, Souweidane MM, Tsiouris AJ, Anand VK, Kacker A, Schwartz TH. Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas. J Neurosurg 2019; 131:1163-1171. [PMID: 30497145 DOI: 10.3171/2018.6.jns18901] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gross-total resection (GTR) of craniopharyngiomas (CPs) is potentially curative and is often the goal of surgery, but endocrinopathy generally results if the stalk is sacrificed. In some cases, GTR can be attempted while still preserving the stalk; however, stalk manipulation or devascularization may cause endocrinopathy and this strategy risks leaving behind small tumor remnants that can recur. METHODS A retrospective review of a prospective cohort of patients who underwent initial resection of CP using the endoscopic endonasal approach over a period of 12 years at Weill Cornell Medical College, NewYork-Presbyterian Hospital, was performed. Postresection integrity of the stalk was retrospectively assessed using operative notes, videos, and postoperative MRI. Tumors were classified based on location into type I (sellar), type II (sellar-suprasellar), and type III (purely suprasellar). Pre- and postoperative endocrine function, tumor location, body mass index, rate of GTR, radiation therapy, and complications were reviewed. RESULTS A total of 54 patients who had undergone endoscopic endonasal procedures for first-time resection of CP were identified. The stalk was preserved in 33 (61%) and sacrificed in 21 (39%) patients. GTR was achieved in 24 patients (73%) with stalk preservation and 21 patients (100%) with stalk sacrifice (p = 0.007). Stalk-preservation surgery achieved GTR and maintained completely normal pituitary function in only 4 (12%) of 33 patients. Permanent postoperative diabetes insipidus was present in 16 patients (49%) with stalk preservation and in 20 patients (95%) following stalk sacrifice (p = 0.002). In the stalk-preservation group, rates of progression and radiation were higher with intentional subtotal resection or near-total resection compared to GTR (67% vs 0%, p < 0.001, and 100% vs 12.5%, p < 0.001, respectively). However, for the subgroup of patients in whom GTR was achieved, stalk preservation did not lead to significantly higher rates of recurrence (12.5%) compared with those in whom it was sacrificed (5%, p = 0.61), and stalk preservation prevented anterior pituitary insufficiency in 33% and diabetes insipidus in 50%. CONCLUSIONS While the decision to preserve the stalk reduces the rate of postoperative endocrinopathy by roughly 50%, nevertheless significant dysfunction of the anterior and posterior pituitary often ensues. The decision to preserve the stalk does not guarantee preserved endocrine function and comes with a higher risk of progression and need for adjuvant therapy. Nevertheless, to reduce postoperative endocrinopathy attempts should be made to preserve the stalk if GTR can be achieved.
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Affiliation(s)
- Edgar G Ordóñez-Rubiano
- Departments of1Neurological Surgery
- 6Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia; and
| | - Jonathan A Forbes
- 7Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | | | | | - Apostolos John Tsiouris
- 5Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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86
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Ramanbhavana VS, Vara Prasad KS. A Case Series of Craniopharyngioma: Epidemiological Study and Management Analysis at Tertiary Care Center. Asian J Neurosurg 2019; 14:1196-1202. [PMID: 31903362 PMCID: PMC6896607 DOI: 10.4103/ajns.ajns_67_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Debate continues as to the optimal treatment for craniopharyngioma; radical surgical resection or partial resection followed by radiotherapy. Radical surgical resection may be complicated by intraoperative injury to surrounding structures and stormy postoperative hormonal problems. This study aims to examine the result of safe maximal surgical resection. METHODOLOGY Retrospective study of all histopathologically proven craniopharyngiomas who had undergone surgical resection over an almost 4-year period was included. Data were collected reviewing demography, clinical presentation, hormonal dysfunction, extent of resection, and visual deterioration. Outcome was measured in terms of Glasgow Outcome Scale and recurrence. RESULTS Of 41 patients, 20(48.8%) were male and 21(51.2%) were female. Age of patients ranged from 1 to 59 years with a mean of 15.9 years. Thirty-seven patients (90%) had headache, 32 patients (78%) had visual disturbances, 23 patients (56%) had vomiting, and 10 patients (24%) had convulsions. Six patients (15%) had memory and sleep disorders and three patients of those >15 years (12.5%) had amenorrhea/sexual dysfunction. Patients who had surgery followed by radiotherapy had better prognosis, so also those aged 18 or less compared to older, males better than females and those without headache had better prognosis, though not statistically significant. CONCLUSIONS Gross total excision if judiciously decided intraoperatively has a favorable outcome with acceptable morbidity. Patient has better prognosis who has surgery with radiotherapy.
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Affiliation(s)
- Venkata Satya Ramanbhavana
- Department of Neurosurgery, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Kadali Satya Vara Prasad
- Department of Neurosurgery, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh, India
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87
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Adib SD, Herlan S, Ebner FH, Hirt B, Tatagiba M, Honegger J. Interoptic, Trans-lamina Terminalis, Opticocarotid Triangle, and Caroticosylvian Windows From Mini-Supraorbital, Frontomedial, and Pterional Perspectives: A Comparative Cadaver Study With Artificial Lesions. Front Surg 2019; 6:40. [PMID: 31380387 PMCID: PMC6646665 DOI: 10.3389/fsurg.2019.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The mini-supraorbital (MSO) and pterional (PT) approaches have been compared in a number of studies focusing on the treatment of aneurysms, craniopharyngiomas, and meningiomas. The goal of this study was to analyze the surgical exposure to different artificial lesions through interoptic (IO), trans-lamina terminalis (TLT), opticocarotid triangle (OCT), and caroticosylvian (CS) windows from the MSO, frontomedial (FM), and PT perspectives. Methods: The MSO, PT, and FM approaches were performed sequentially in two fixed cadaver heads. Three colored spheres were placed around the optic chiasm: (1) between the optic nerves; (2) between the optic nerve and the internal carotid artery; and (3) between the internal carotid artery and the oculomotor nerve. The surgical exposures to these structures by using the IO, TLT, OCT, and CS windows were compared. Results: (1) IO window: from the MSO and PT approaches, the total surgical exposure mainly allows visualization of contralateral lesions. The FM approach was superior for exploration of both sides of the area between the optic nerves. (2) TLT pathway: the MSO and PT approaches mainly expose the contralateral third ventricle wall. (3) OCT window: the PT approach allows exposure of a larger part of the sphere between the optic nerve and the internal carotid artery than the MSO approach. (4) CS window: the PT approach allows a better exposure of lateral structures such as the oculomotor nerve and of the medial prepontine area in comparison to the MSO approach. Conclusion: Simulation of the surgical situation with artificial lesions is a good model for comparing surgical perspectives and for analyzing feasibility of lesion exposure and resection.
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Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Stephan Herlan
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
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Kaltsas GA, Kolomodi D, Randeva H, Grossman A. Nonneuroendocrine Neoplasms of the Pituitary Region. J Clin Endocrinol Metab 2019; 104:3108-3123. [PMID: 30779850 DOI: 10.1210/jc.2018-01871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
CONTEXT Although most sellar lesions are related to pituitary adenomas, the region gives rise to a variety of neoplasms that can be associated with substantial morbidity and/or mortality. DESIGN Information from reviews and guidelines of relevant societies dealing with such neoplasms, as well as articles that have provided new developments that made important contributions to their pathogenesis and treatment up to 2018, were obtained: public indexes such as PubMed/MEDLINE were used with the relevant search items. RESULTS Sellar neoplasms have a worse outcome than pituitary adenomas that is related not only to their natural history but also to side effects of therapies and evolving endocrine and/or hypothalamic deficiencies. Recent imaging advances have established the radiological fingerprint of some of these neoplasms, and several chromosomal aberrations have also been identified. Although established approaches along with new surgical and radiotherapeutic approaches remain the main treatment modalities, recent evidence has provided insight into their molecular pathogenesis involving, other than chemotherapy, treatments with targeted agents as in gliomas and craniopharyngiomas bearing BRAF mutations. Development of predictive markers of recurrences may also identify high-risk patients, including proliferative markers and expression of the progesterone receptor in meningiomas, and lead to less aggressive surgery. Owing to the rarity and complexity of these neoplasms, patients should be managed in dedicated centers. CONCLUSIONS The diagnosis and management of sellar neoplasms necessitate a multidisciplinary approach. Following evolving recent advances in their diagnosis and therapy, such a multidisciplinary approach needs to be extended to establish evidence-based diagnostic and management plans.
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Affiliation(s)
- Gregory A Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Ashley Grossman
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
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Jamshidi AO, Beer-Furlan A, Prevedello DM, Sahyouni R, Elzoghby MA, Safain MG, Carrau RL, Jane JA, Laws ER. A modern series of subdiaphragmatic craniopharyngiomas. J Neurosurg 2019; 131:526-531. [PMID: 30485192 DOI: 10.3171/2018.4.jns172330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The endoscopic endonasal approach has been proposed as a primary surgical strategy for select craniopharyngiomas. However, those tumors that arise from the sella have not been classified with the other craniopharyngioma subtypes in terms of surgical nuances, intraoperative findings, and postoperative outcomes. The authors describe their experience with a select subtype of craniopharyngioma arising within the sella subjacent to the diaphragma sellae and refer to these tumors as type 0. METHODS After obtaining IRB approval, three institutions retrospectively reviewed their data collected from 2005 to 2017. Patients eligible for inclusion in the study were those who had tumors that originated from the sella inferior to the diaphragma sellae. Demographic, clinical, radiological, surgical, and follow-up data were examined and analyzed. RESULTS Twenty-eight patients (average age 19.3 years, range 3-60 years) were included in this study. Sixteen patients (57%) were younger than 18 years of age. All patients had characteristic imaging features of an expanded sella. Seventy-five percent of the patients presented with some form of visual field deficit (89% had radiographic optic apparatus compression) and 39% with hypopituitarism. The average maximal tumor diameter in the axial, coronal, or sagittal plane was 3.1 cm. Gross-total resection was achieved in 82% of the patients. Twenty-one percent of patients experienced an iatrogenic complication, and there were only two cases (7%) of postoperative cerebrospinal fluid (CSF) leakage. Only two patients (7%) required the use of a nasoseptal flap as part of their original reconstruction. Pathology was uniformly the adamantinomatous subtype. Postoperative objective visual outcomes were improved in 71% of the patients with visual symptoms or visual field deficits on presentation and stable in 24%. Mean follow-up was 45.1 months (range 3-120 months) with an 18% recurrence rate at a mean of 44.4 months (range 10-84 months). One patient was lost to follow-up. Thirty-six percent of patients received postoperative radiation to treat recurrence or residual tumor. Endocrine data are also presented. CONCLUSIONS Craniopharyngiomas that originate within the sella below the diaphragma sellae are a select subtype characterized by 1) an enlarged sella, 2) an intact diaphragma sellae at surgery, and 3) an adamantinomatous pathology. These tumors can be treated transnasally without the absolute need for neurovascular flap reconstruction, as there is a low risk of CSF leakage.
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Affiliation(s)
| | | | - Daniel M Prevedello
- Departments of1Neurological Surgery and
- 2Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ronald Sahyouni
- 3Department of Biomedical Engineering, University of California, Irvine, California
| | - Mohamed A Elzoghby
- 4Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
- 5Neurosurgery Department, Ain Shams University, Cairo, Egypt; and
| | - Mina G Safain
- 6Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ricardo L Carrau
- Departments of1Neurological Surgery and
- 2Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - John A Jane
- 4Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Edward R Laws
- 6Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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90
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Juratli TA, Jones PS, Wang N, Subramanian M, Aylwin SJB, Odia Y, Rostami E, Gudjonsson O, Shaw BL, Cahill DP, Galanis E, Barker FG, Santagata S, Brastianos PK. Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations. Cancer 2019; 125:2910-2914. [PMID: 31314136 DOI: 10.1002/cncr.32197] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tareq A Juratli
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Faculty of Medicine and Carl Gustav, Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy Wang
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megha Subramanian
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon J B Aylwin
- Department of Endocrinology, King's College Hospital, London, United Kingdom
| | - Yazmin Odia
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Elham Rostami
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olafur Gudjonsson
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Brian L Shaw
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priscilla K Brastianos
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Neurology and Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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91
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Gauden AJ, Harley B, Pears C, Wickremesekera A, Parker A, Robinson S, Baguley C, Wormald PJ. A regional Australasian experience of extended endoscopic transsphenoidal surgery for craniopharyngioma: Progression of the mentoring model. J Clin Neurosci 2019; 68:188-193. [PMID: 31303398 DOI: 10.1016/j.jocn.2019.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/22/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
Endoscopic endonasal transsphenoidal approaches to craniopharyngioma has become increasingly popular over the last 15 years. We present the results of our retrospective series of craniopharyngiomata resected by an endoscopic, endonasal approach at a low-volume service in Australasia. Between the years of 2009 and 2017, 11 patients underwent pure endoscopic endonasal transsphenoidal resection for a craniopharyngioma at our institutions. The medical records, histopathology, intraoperative findings and patient imaging were retrospectively assessed. 11 patients were included with 5 male and 6 female patients. The mean age was 32.0 years (range 14-68 years). Of this patient series a gross total resection of the tumour was achieved in 8 of 11 patients (73%). In the immediate postoperative phase, 10 of the 11 patients developed diabetes insipidus (91%). The pituitary stalk was formally not seen in 4 patients and all were treated with vasopressin. Of the 7 patients where the pituitary stalk was identified it was formally divided in 6 and preserved in 1 patient where the tumour was separate to the stalk. The endoscopic endonasal transsphenoidal approach for excision of craniopharyngioma, utilising and progressing the surgical mentoring model, can achieve adequate decompression of critical structures. Furthermore, our aggressive approach to divide and remove the involved pituitary stalk results in high rates of gross macroscopic resection with excellent long-term disease control with a greater risk of postoperative diabetes insipidus and panhypopituitarism.
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Affiliation(s)
- A J Gauden
- Department of Neurosurgery, Wellington Hospital, New Zealand; Department of Neurosurgery, Royal Melbourne Hospital, Australia.
| | - B Harley
- Department of Neurosurgery, Wellington Hospital, New Zealand
| | - C Pears
- Department of Neurosurgery, Wellington Hospital, New Zealand
| | | | - A Parker
- Department of Neurosurgery, Wellington Hospital, New Zealand
| | - S Robinson
- Department of Otolaryngology, Wellington Hospital, New Zealand
| | - C Baguley
- Department of Otolaryngology, Wellington Hospital, New Zealand
| | - P J Wormald
- Department Otolaryngology, Royal Adelaide Hospital, Australia
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92
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Mourad F, Cataldi F, Patuzzo A, Tunnera S, Dunning J, Fernández-de-Las-Peñas C, Maselli F. Craniopharyngioma in a young woman with symptoms presenting as mechanical neck pain associated with cervicogenic headache: a case report. Physiother Theory Pract 2019; 37:549-558. [PMID: 31271335 DOI: 10.1080/09593985.2019.1636433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Craniopharyngioma is benign neoplasm thought to be caused by mal-development, which occurs in both children and adults in the sellar and suprasellar regions of the brain. Typical manifestations in adults are visual and endocrine system symptoms followed by signs and symptoms of increased intracranial pressure (i.e., headache). The management of this rare condition is complex and requires life-long surveillance by a multidisciplinary team of health-care professionals.Objective: To present a rare clinical presentation of craniopharyngioma mimicking nonspecific neck pain usually associated with cervicogenic headache recognized by a physiotherapist in a direct access setting as a condition requiring medical referral.Case Presentation: This case report describes the history, examination findings, and clinical reasoning used in the initial examination of a 33-year-old female with neck pain and cervicogenic headache as chief complaints. Several key indicators in the patient presentation warranted further and urgent investigation: 1) the recent onset of a "new-type" headache; 2) the phenotype headaches change; 3) the rapid progression of the symptoms; 4) the presence of associated neurological signs and symptoms; and 5) the worsening of the symptoms during Valsalva-like activities. The decision was made to refer the patient for further evaluation. An MRI revealed a craniopharyngioma. After a surgical removal of the tumor mass, the patient participated in a rehabilitation program and reached a full recovery after 6 months.Conclusion: This case report highlights the need of more research regarding red flags and warning signs during examination of in the head-neck region, and the central role of primary care clinicians such as physiotherapists in differential diagnosis of life-threatening conditions.
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Affiliation(s)
- Firas Mourad
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.,Poliambulatorio Physio Power, Brescia, Italy.,Facoltà di Medicina e Chirurgia, Università degli Studi di Tor Vergata, Roma, Italy.,Facoltà di Medicna e Chirurgia, Dipartimento di Scienze Cliniche e Sperimentali, Università degli studi di Brescia, Brescia, Italy
| | - Fabio Cataldi
- Facoltà di Medicina e Chirurgia, Università degli Studi di Tor Vergata, Roma, Italy.,MTLab Physiotherapy, Bari, Italy
| | - Alberto Patuzzo
- Facoltà di Medicina e Chirurgia, Università degli Studi di Tor Vergata, Roma, Italy.,Agorà Medical, Verona, Italy.,Scuola di Medicina e Chirurgia, Dipartimento di Fisioterapia e Riabilitazione, Università degli studi di Verona, Verona, Italy
| | - Sara Tunnera
- Facoltà di Medicina e Chirurgia, Università degli Studi di Tor Vergata, Roma, Italy
| | - James Dunning
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Filippo Maselli
- DINOGMI Department, Genova University, Genova, Italy.,Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
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Hara T, Akutsu H, Takano S, Kino H, Ishikawa E, Tanaka S, Miyamoto H, Sakamoto N, Hattori K, Sakata-Yanagimoto M, Chiba S, Hiyama T, Masumoto T, Matsumura A. Clinical and biological significance of adamantinomatous craniopharyngioma with CTNNB1 mutation. J Neurosurg 2019; 131:217-226. [PMID: 30074466 DOI: 10.3171/2018.3.jns172528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Wnt/β-catenin signaling pathway is strongly implicated in the pathogenesis of adamantinomatous craniopharyngioma (adaCP). However, there is no evidence that the CTNNB1 mutation activates the target gene of Wnt/β-catenin signaling, and it is unknown whether it affects the tumorigenesis of adaCP. To assess the effect of the CTNNB1 mutation of adaCP, the authors analyzed the correlation between the mutation and clinical, radiological, pathological, and biological findings. METHODS Between 2003 and 2015, 42 patients (24 male and 18 female, median age 42 years) with either papillary craniopharyngioma (papCP) or adaCP underwent tumor resection at the authors' institution. BRAF V600E and CTNNB1 in papCP and adaCP samples were sequenced by next-generation sequencing and the Sanger method, and mRNA expression levels of Axin2 and BMP4 were evaluated by RT-PCR. Axin2, BMP4, β-catenin, and BRAF expression were evaluated by immunohistochemistry. Other data were collected from clinical reports. RESULTS The BRAF V600E mutation was detected in all 10 cases of papCP (100%). CTNNB1 exon 3 mutations were detected in 21 of 31 (68%) cases of adaCP, excluding 1 case for which there were no available sequence data. The mRNA expression level of Axin2 was significantly higher in adaCPs with a CTNNB1 mutation than in those without (p < 0.05). The immunohistochemical findings of Axin2 and BMP4 did not correlate with CTNNB1 mutation positivity. When patients who received adjuvant radiation therapy were excluded, progression-free survival was shorter in the mutation-positive group than in the mutation-negative group (log-rank test, p = 0.031). Examination of clinical characteristics and immunohistochemical findings of adaCPs showed that there was no significant correlation between CTNNB1 mutation positivity and age, sex, tumor volume, gross-total resection, optic tract edema, calcification, or T1 signal intensity of cyst fluid on MRI, β-catenin, and MIB-1 index. CONCLUSIONS These results raise the possibility that the CTNNB1 mutation in adaCP may be associated with disease recurrence, and genes related to the Wnt/β-catenin signaling pathway might represent a therapeutic target.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Takashi Hiyama
- 5Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomohiko Masumoto
- 5Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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94
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Clusmann H, Höllig A. Craniopharyngioma: The Benefits of a Conservative Approach. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:319-320. [PMID: 31219032 PMCID: PMC6620758 DOI: 10.3238/arztebl.2019.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Hans Clusmann
- Department of Neurosurgery, University Hospital RWTH Aachen
| | - Anke Höllig
- Department of Neurosurgery, University Hospital RWTH Aachen
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95
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Qiao N. Excess mortality after craniopharyngioma treatment: are we making progress? Endocrine 2019; 64:31-37. [PMID: 30569259 DOI: 10.1007/s12020-018-1830-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Craniopharyngioma is associated with an increased risk of mortality even after surgical, radiotherapeutic and hormone supplementations. Previous studies using different designs showed a possible trend of decreasing mortality in recent years. This review summarises studies reporting standardised mortality ratio (SMR) after craniopharyngioma treatment, as well as the bias and confounding in these studies to plan further researches. METHODS PubMed and Embase was searched for manuscripts published before October 2018 using medical subject heading terms ("craniopharyngioma" or "hypopituitarism" and "mortality"). RESULTS Eight studies reported SMR after craniopharyngioma treatment, with a total of 2802 patients. The subgroup meta-analysis using random effects model was conducted to pool the SMR, which was 6.2 (95% CI 4.1-9.4) before 2010 and 2.9 (95% CI 2.2-3.8) after 2010 (subgroup test p < 0.01), respectively. Misclassification (one study) and selection bias (six studies) either inflated or deflated the result. The trend of increasing survival rate over the time was observed in studies without reporting SMR. Female patients, childhood-onset disease, hydrocephalus, tumour recurrence, body mass index and panhypopituitarism were identified as the important risk factors for excess mortality. CONCLUSIONS Though bias and confounding existed across studies, the decreasing SMR and increasing survival rate over the time was in favour of a real signal. It is necessary to launch studies to further investigate the morality and risk factors after multidisciplinary treatment of craniopharyngioma in a hospital-based manner, using the modern statistical method to adjust for bias and confounding.
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Affiliation(s)
- Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai, China.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
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96
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Radovanovic I, Dehdashti AR, Turel MK, Almeida JP, Godoy BL, Doglietto F, Vescan AD, Zadeh G, Gentili F. Expanded Endonasal Endoscopic Surgery in Suprasellar Craniopharyngiomas: A Retrospective Analysis of 43 Surgeries Including Recurrent Cases. Oper Neurosurg (Hagerstown) 2019; 17:132-142. [DOI: 10.1093/ons/opy356] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 10/22/2018] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDThe role of expanded endonasal endoscopic surgery for primary and recurrent craniopharyngioma is not yet fully established.OBJECTIVETo report and evaluate our experience with the endoscopic endonasal approach (EEA) for the resection of primary and recurrent craniopharyngiomas.METHODSThis is a retrospective cohort analysis of 43 consecutive EEA procedures in 40 patients operated from September 2006 to February 2012 for suprasellar craniopharyngiomas. In 21 patients (48.8%) the disease was recurrent. We have assessed the surgical results, visual, endocrinological, and functional outcomes and resection rates in this patient cohort.RESULTSAt presentation, 31 (72.1%) patients had visual deficits, 15 patients (34.9%) complained of headaches, 25 patients (58.1%) had anterior pituitary insufficiency, and 14 (32.5%) had diabetes insipidus. Total resection was achieved in 44.2% surgeries, of which 77.3% were in primary lesions and 9.5% in recurrent lesions (P < .001). Vision improved in 92.6% patients and worsened in 2.3%. Complications other than vision were encountered in 25.6% including 9/43 cerebrospinal fluid leak, 2/43 meningitis. A total of 51.9% of patients with preoperative residual anterior pituitary function had new anterior pituitary deficiencies and 42.8% had new diabetes insipidus. There was no mortality. Six patients (14%) had recurrence of disease during the follow-up period (mean 56.8 mo), 5 of which required repeat surgery.CONCLUSIONThe EEA can be integrated in the overall management of both primary and recurrent craniopharyngiomas with good results; however, in our series recurrent surgery was associated with significantly lower rates of gross total resection.
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Affiliation(s)
- Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
| | - Amir R Dehdashti
- Department of Neurosurgery, Northshore University Hospital, Northwell Health, Manhasset, New York
| | - Mazda K Turel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
| | - Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
| | - Bruno L Godoy
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
| | - Francesco Doglietto
- Instituto di Neurochirurgia, Universita di Brescia/Spedali Civili, Brescia, Italy
| | - Allan D Vescan
- Division of Otolaryngology, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada
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97
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Single-Center Surgical Experience of the Treatment of Craniopharyngiomas With Emphasis on the Operative Approach: Endoscopic Endonasal and Open Microscopic Transcranial Approaches. J Craniofac Surg 2019; 29:e572-e578. [PMID: 29863551 DOI: 10.1097/scs.0000000000004592] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to report the authors' single-center clinical experience about craniopharyngiomas and discuss surgical outcomes of these patients according to the type of surgical approach (endoscopic endonasal or open microscopic transcranial approach).Twenty-four patients diagnosed with craniopharyngiomas between May 2013 and April 2017 were considered for inclusion. The patients were divided into 2 groups according to the surgical approach (open transcranial microscopic approach [group A] and endoscopic endonasal approach [group B]). These groups were compared in terms of postoperative surgical outcome scores (extent of tumor removal, visual deficit, hydrocephalus, metabolic disorders, and Glasgow coma scale) and hospitalization interval.There was no patient of mortality in both groups. In this study, 4 of the 13 patients in group A and 9 of the 11 patients in group B underwent gross total resection. However, 1 patient in group B underwent repair because of cerebrospinal fluid leakage postoperatively. In addition, 1 patient in group A had a wound healing problem postoperatively. The postoperative outcome scores were 9.5 in group A and 11.5 in group B. The hospitalization interval in group A (range, 7-9 days) was longer than that in group B (range, 5-7 days).The endoscopic endonasal approach should be considered the first-line surgical treatment modality in patients with a preliminary diagnosis of craniopharyngioma in terms of low complication risk, minimal invasiveness, and better outcome scores. Open microscopic transcranial procedures may be combined with this approach in a single session for challenging cases.
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98
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Fujio S, Juratli TA, Arita K, Hirano H, Nagano Y, Takajo T, Yoshimoto K, Bihun IV, Kaplan AB, Nayyar N, Fink AL, Bertalan MS, Tummala SS, Curry, Jr WT, Jones PS, Martinez-Lage M, Cahill DP, Barker FG, Brastianos PK. A Clinical Rule for Preoperative Prediction of BRAF Mutation Status in Craniopharyngiomas. Neurosurgery 2018; 85:204-210. [DOI: 10.1093/neuros/nyy569] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Papillary craniopharyngiomas are characterized by BRAFV600E mutations. Targeted therapy can elicit a dramatic radiographic regression of these tumors. Therefore, prediction of BRAF mutation status before definitive surgery could enable neoadjuvant treatment strategies.
OBJECTIVE
To establish preoperative prediction criteria to identify patients with a BRAF mutant craniopharyngioma.
METHODS
Sixty-four patients with craniopharyngioma were included in this study. We determined BRAF mutation status by targeted sequencing. After scoring interobserver variability between presurgical clinical data and radiographic features, we established a diagnostic rule for BRAF mutation in our discovery cohort. We then validated the rule in an independent cohort.
RESULTS
The BRAFV600E mutation was detected in 12 of 42 patients in the discovery cohort. There were no patients under age 18 with BRAF mutation. Calcification was rare in tumors with BRAF mutation (P < .001), and 92% of them were supradiaphragmatic in location. Combining these 3 features—older than 18 years, absence of calcification, and supradiaphragmatic tumor location—we established a rule for predicting BRAF mutation. In cases where all 3 criteria were fulfilled, the sensitivity and specificity for the presence of BRAF mutation were 83% and 93%, respectively. In the validation cohort (n = 22), the sensitivity was 100% and specificity was 89%.
CONCLUSION
We propose predictive criteria for a BRAF mutation in craniopharyngioma using preoperative clinical and radiographic data. This rule may be useful in identifying patients who could potentially benefit from neoadjuvant BRAFV600E-targeted systemic therapies.
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Affiliation(s)
- Shingo Fujio
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Tareq A Juratli
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yushi Nagano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Tomoko Takajo
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ivanna V Bihun
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander B Kaplan
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Naema Nayyar
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Alexandria L Fink
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mia S Bertalan
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Shilpa S Tummala
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William T Curry, Jr
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priscilla K Brastianos
- Divisions of Neuro-Oncology and Hematology/Oncology, Departments of Medicine and Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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99
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Trans-eyebrow supraorbital keyhole approach in suprasellar and third ventricular craniopharyngioma surgery: the experience of 27 cases and a literature review. J Neurooncol 2018; 141:363-371. [PMID: 30392089 DOI: 10.1007/s11060-018-03041-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The trans-eyebrow supraorbital keyhole approach, a minimal transcranial approach, has been widely used in different types of surgery for sellar and parasellar lesions. In this study, we investigated the outcome of this approach in the surgical treatment of suprasellar and third ventricular craniopharyngioma. METHODS Twenty-seven patients with suprasellar and third ventricular craniopharyngioma underwent surgery via a supraorbital approach between June 2007 and June 2018. The medical data and follow-up results were retrospectively analyzed. RESULTS All tumors were located in the suprasellar region and the third ventricle. The mean tumor size was 29.1 mm. The mean follow-up period was 49.6 months. Gross total resection (GTR) was achieved in 23 patients (85.2%). Of 17 patients with preoperative visual impairment, 12 patients (70.6%) showed improvement. Following surgery, 11 patients exhibited new-onset anterior hypopituitarism, ten developed diabetes insipidus, and two became overweight. One residual tumor relapsed 1 year after surgery. No perioperative death, cerebrospinal fluid (CSF) rhinorrhea, or meningitis occurred. All patients exhibited satisfactory cosmetic results. At the last follow-up, the Extended Glasgow Outcome Scale Score was 8 in 25 patients (92.6%). CONCLUSION The supraorbital trans-eyebrow keyhole approach is characterized by minimal invasion and a satisfactory cosmetic outcome. According to our experience, craniopharyngiomas located in the suprasellar region and the third ventricle can be safely resected via a trans-eyebrow supraorbital keyhole approach.
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100
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Capatina C, Vintila M, Gherlan I, Dumitraşcu A, Caragheorgheopol A, Procopiuc C, Ciubotaru V, Poiana C. CRANIOPHARYNGIOMA - CLINICAL AND THERAPEUTIC OUTCOME DATA IN A MIXED COHORT OF ADULT AND PAEDIATRIC CASES. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:549-555. [PMID: 31149311 PMCID: PMC6516416 DOI: 10.4183/aeb.2018.549] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Craniopharyngiomas are benign but locally invasive tumours of the sellar region that arise from ectopic embryonic remnants of Rathke's pouch, affecting both children (adamantinomatous type -aCP) and adults (papillary type -pCP) and associated with significant morbidity. OBJECTIVE To study the clinical presentation of CRF as well as the posttreatment evolution of craniopharyngioma in children versus adults in a large mixed cohort. MATERIAL AND METHODS We performed a retrospective review of CRF patients evaluated in the National Institute of Endocrinology in Bucharest between 1990 and 2016. RESULTS A total of 107 patients (72 adults, 35 children) with a mean follow-up of 6.2 years were included. The presenting symptoms were mostly headache, visual impairment, symptoms of hypopituitarism, diabetes insipidus. Some symptoms or hormonal abnormalities were significantly more prevalent in the children group (p<0.05): nausea/ vomiting (47.8% vs 16.7%), photophobia (21.7% vs 5.6%), diabetes insipidus(28.5% vs 8.3%), GH deficiency (68.8% vs 17.1%). Impaired visual acuity (67.6%of cases) or visual fields (71.4%) were more frequent in adults compared to children (44.1%; 51.6%). The tumor dimensions were similar in both groups (3.05± 1.05 cm in children; 2.7± 1.07 cm in adults). Massive suprasellar extension reaching the third ventricle was frequently present in all cases. All cases underwent surgery but only a minority of those not cured received postoperative adjuvant radiotherapy. Frequent postoperative complications were: aggravation of the endocrine deficit (>80% of cases in both groups needed chronic replacement therapy), central diabetes insipidus (68.2% children, 34.3% of adults). CONCLUSIONS Despite similar tumor dimensions and extension compared to adults, craniopharyngioma in children is more frequently associated with signs of intracranial pressure. The results and complications of treatment are similar in adults and children.
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Affiliation(s)
- C. Capatina
- “Carol Davila” University of Medicine and Pharmacy, Dept. of Endocrinology, Bucharest, Romania
- “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
| | - M. Vintila
- “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
| | - I. Gherlan
- “Carol Davila” University of Medicine and Pharmacy, Dept. of Endocrinology, Bucharest, Romania
- “C.I. Parhon” National Institute of Endocrinology, Pediatric Endocrinology, Bucharest, Romania
| | - A. Dumitraşcu
- “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
| | | | - C. Procopiuc
- “C.I. Parhon” National Institute of Endocrinology, Pediatric Endocrinology, Bucharest, Romania
| | - V. Ciubotaru
- Bagdasar Arseni Hospital - Neurosurgery, Bucharest, Romania
| | - C. Poiana
- “Carol Davila” University of Medicine and Pharmacy, Dept. of Endocrinology, Bucharest, Romania
- “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
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