101
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Zygourakis CC, Kaur G, Kunwar S, McDermott MW, Madden M, Oh T, Parsa AT. Modern treatment of 84 newly diagnosed craniopharyngiomas. J Clin Neurosci 2014; 21:1558-66. [DOI: 10.1016/j.jocn.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
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102
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Venegas E, Concepcion B, Martin T, Soto A. [Practice guideline for diagnosis and treatment of craniopharyngioma and parasellar tumors of the pituitary gland]. ACTA ACUST UNITED AC 2014; 62:e1-13. [PMID: 25066506 DOI: 10.1016/j.endonu.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/02/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Craniopharyngiomas are rare, locally aggressive epithelial tumors usually located in the sellar and suprasellar region. Diagnosis of craniopharyngioma is usually suggested by clinical and radiological findings that should be confirmed histologically. Surgery is the treatment of choice for most patients. The goal of surgery is to relieve compressive symptoms and to remove as much tumor as safely possible. Radiation therapy is the usual treatment to control postoperative tumor remnants and local recurrences. Parasellar lesions are low prevalent lesions and include neoplastic, inflammatory, infectious, developmental, and vascular diseases. Both their diagnosis and treatment depend on the type of lesion.
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Affiliation(s)
- Eva Venegas
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Blanco Concepcion
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Tomas Martin
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Alfonso Soto
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
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103
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Xiao G, Yuan X, Yuan J, Krumtally NA, Li Y, Feng C, Liu Q, Peng Z, Li X, Ding X. Pituitary stalk management during the microsurgery of craniopharyngiomas. Exp Ther Med 2014; 7:1055-1064. [PMID: 24940387 PMCID: PMC3991534 DOI: 10.3892/etm.2014.1561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 02/07/2014] [Indexed: 11/06/2022] Open
Abstract
In the present study, 203 patients that had previously undergone microsurgery for craniopharyngiomas (CPs) between 1992 and 2012 were analyzed retrospectively on a long-term follow-up basis to investigate the differences in the recurrence rate and endocrine function between patients with preserved and resected pituitary stalks. To summarize the possible outcomes of microsurgery, the 203 patients were divided into 2 groups: Group A that had preserved pituitary stalks and Group B that had undergone resections of the pituitary stalk. Tumor origins and the involvement of the pituitary stalk during surgery were observed. From 2010 onwards, an ultra-electron microscope was used postoperatively to detect whether pituitary stalk specimens were infiltrated or invaded with tumor cells. Long-term follow-up observations of the patients included tumor recurrence, postoperative endocrine dysfunction and visual acuity and field. Among the 203 patients, 175 patients received gross-total resection (GTR) (175/203, 86.2%), 28 patients underwent subtotal resection (28/203, 13.8%) and 34 patients had surgery that preserved the pituitary stalk (34/203, 16.7%). There was no significant difference in the recurrence rate between Group A (4/34, 11.8%) and the patients in Group B (10/123, 8.1%) who underwent GTR and also received follow-ups. Of the 157 patients who were followed up, 91 individuals underwent endocrine evaluation and the outcome was divided into normal, satisfactory and poor grades. The results for Group A were 5, 18 and 0, respectively, while the results for Group B were 1, 60 and 7, respectively, which showed a statistically significant difference between the groups. Pituitary stalk specimens of 15 patients were studied postoperatively using an ultra-electron microscope and all samples showed tumor cells had invaded the pituitary stalk (15/15, 100%). Total resections of CPs with the pituitary stalk were recommended if the pituitary stalk was intraoperatively invaded. In cases where the pituitary stalk was not involved, microsurgical excisions preserving the pituitary stalk were preferred, as there was no significant increase in the recurrence rate and the patients experienced less endocrine dysfunction.
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Affiliation(s)
- Gelei Xiao
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xianrui Yuan
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jian Yuan
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Nadeem Akhtar Krumtally
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yifeng Li
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Chengyuan Feng
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qing Liu
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zefeng Peng
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xuejun Li
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiping Ding
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Abstract
Craniopharyngiomas are embryogenic malformations of the sellar region. With an overall incidence of 0.5-2.0 new cases per million population per year, approximately 30-50% of all cases represent childhood craniopharyngioma. Therapy of choice in patients with favorable tumor localization is complete resection with a specific focus on maintaining functions of the optical nerve and hypothalamic-pituitary axes. In patients whose unfavorable tumor localization makes maintaining hypothalamic functionality surgically challenging, a limited resection followed by local irradiation is recommended. The overall survival rates are high (92%) but relapses and reduced QoL in survivors are also frequent. Because irradiation is efficient in preventing tumor progression, appropriate timing of post-surgical irradiation is currently under investigation in a randomized trial (KRANIOPHARYNGEOM 2007). Childhood craniopharyngioma should be recognized as a chronic disease requiring constant monitoring of the clinical and QoL consequences in order to provide optimal care of surviving patients.
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Affiliation(s)
- Hermann L Müller
- Department of Pediatrics, Klinikum Oldenburg, Oldenburg 26133, Germany
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105
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Rosenfeld A, Arrington D, Miller J, Olson M, Gieseking A, Etzl M, Harel B, Schembri A, Kaplan A. A review of childhood and adolescent craniopharyngiomas with particular attention to hypothalamic obesity. Pediatr Neurol 2014; 50:4-10. [PMID: 24188907 DOI: 10.1016/j.pediatrneurol.2013.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/28/2013] [Accepted: 09/09/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although craniopharyngiomas are considered "benign" neoplasms by the World Health Organization classification, these tumors may create significant morbidity and mortality in patients. Hypothalamic obesity is a frequent complication of craniopharyngiomas and is refractory to current management options. PATIENTS/METHODS We reviewed 24 cases of craniopharyngiomas treated from 1992 to 2010 in patients <18 years of age regarding clinical presentation, neuroimaging, recurrence, morbidity, and mortality, with particular attention to hypothalamic obesity. RESULTS Our cohort conformed to published data in regard to neuroimaging characteristics, and clinical findings in the areas of endocrine, visual, neurological, neurobehavioral, and hypothalamic domains. At last follow-up, 53% of our patients were overweight (8%) or obese (46%). Only 25% of our patients had a healthy body mass index. Contrasting these data with body mass indices at diagnosis, where 21% of patients were overweight and 17% were obese, we found that there was a significant trend towards obesity over time. A significant portion of our mortality appears to be related to complications of obesity. The Native American population in Arizona appears to have a statistically greater incidence of obesity in childhood. Despite our small sample size, 75% of our Native Americans were obese at last follow-up and accounted for 50% of the mortality. CONCLUSION Hypothalamic obesity is a significant complication of craniopharyngiomas associated with increased mortality. The development of hypothalamic obesity is influenced by premorbid obesity, genetics, and therapy received, specifically radiation. Because of the intractability of hypothalamic obesity, improved understanding of neuroendocrine mechanisms, genomics, and newer antiobesity medications will be necessary to curb this significant complication.
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Affiliation(s)
- Amy Rosenfeld
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona.
| | - Daniel Arrington
- Department of Neurology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey Miller
- Division of Neuro-radiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Micah Olson
- Division of Endocrinology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Annie Gieseking
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona
| | - Michael Etzl
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona
| | - Brian Harel
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut; Cogstate Ltd, Melbourne, Australia
| | | | - Allen Kaplan
- Division of Child Neurology, Phoenix Children's Hospital, Phoenix, Arizona
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106
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Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 2013; 119:1194-207. [PMID: 23909243 DOI: 10.3171/2013.6.jns122259] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The proximity of craniopharyngiomas to vital neurovascular structures and their high recurrence rates make them one of the most challenging and controversial management dilemmas in neurosurgery. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for both pediatric and adult craniopharyngiomas. The object of the present study was to present the results of EES and analyze outcome in both the pediatric and the adult age groups. METHODS The authors retrospectively reviewed the records of patients with craniopharyngioma who had undergone EES in the period from June 1999 to April 2011. RESULTS Sixty-four patients, 47 adults and 17 children, were eligible for this study. Forty-seven patients had presented with primary craniopharyngiomas and 17 with recurrent tumors. The mean age in the adult group was 51 years (range 28-82 years); in the pediatric group, 9 years (range 4-18 years). Overall, the gross-total resection rate was 37.5% (24 patients); near-total resection (> 95% of tumor removed) was 34.4% (22 patients); subtotal resection (≥ 80% of tumor removed) 21.9% (14 patients); and partial resection (< 80% of tumor removed) 6.2% (4 patients). In 9 patients, EES had been combined with radiation therapy (with radiosurgery in 6 cases) as the initial treatment. Among the 40 patients (62.5%) who had presented with pituitary insufficiency, pituitary function remained unchanged in 19 (47.5%), improved or normalized in 8 (20%), and worsened in 13 (32.5%). In the 24 patients who had presented with normal pituitary function, new pituitary deficit occurred in 14 (58.3%). Nineteen patients (29.7%) suffered from diabetes insipidus at presentation, and the condition developed in 21 patients (46.7%) after treatment. Forty-four patients (68.8%) had presented with impaired vision. In 38 (86.4%) of them, vision improved or even normalized after surgery; in 5, it remained unchanged; and in 1, it temporarily worsened. One patient without preoperative visual problems showed temporary visual deterioration after treatment. Permanent visual deterioration occurred in no one after surgery. The mean follow-up was 38 months (range 1-135 months). Tumor recurrence after EES was discovered in 22 patients (34.4%) and was treated with repeat surgery (6 patients), radiosurgery (1 patient), combined repeat surgery and radiation therapy (8 patients), interferon (1 patient), or observation (6 patients). Surgical complications included 15 cases (23.4%) with CSF leakage that was treated with surgical reexploration (13 patients) and/or lumbar drain placement (9 patients). This leak rate was decreased to 10.6% in recent years after the introduction of the vascularized nasoseptal flap. Five cases (7.8%) of meningitis were found and treated with antibiotics without further complications. Postoperative hydrocephalus occurred in 7 patients (12.7%) and was treated with ventriculoperitoneal shunt placement. Five patients experienced transient cranial nerve palsies. There was no operative mortality. CONCLUSIONS With the goal of gross-total or maximum possible safe resection, EES can be used for the treatment of every craniopharyngioma, regardless of its location, size, and extension (excluding purely intraventricular tumors), and can provide acceptable results comparable to those for traditional craniotomies. Endoscopic endonasal surgery is not limited to adults and actually shows higher resection rates in the pediatric population.
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107
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Pratheesh R, Swallow DMA, Rajaratnam S, Jacob KS, Chacko G, Joseph M, Chacko AG. Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults. Childs Nerv Syst 2013; 29:941-9. [PMID: 23386174 DOI: 10.1007/s00381-013-2041-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 01/25/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aims to determine the incidence, predictors, early post-operative course of diabetes insipidus (DI) in paediatric craniopharyngiomas(CP) and compare the findings with adults. METHODS Retrospective analysis of clinical, biochemical, radiological and operative data for 102 consecutive CP surgeries (45 paediatric and 57 adult cases) was done. Bivariate and multivariate analyses were done to determine the predictors of DI. The incidence of the triphasic response and electrolyte abnormalities in the first post-operative week was compared between children and adults. RESULTS Children had larger tumours and higher incidence of cystic tumours and hydrocephalus. Preoperative DI was close to 15 % in both the age groups. Radical/subtotal excision was achieved in 58 % of children and 53 % of adults. The incidence of post-operative DI was 80 % and 63 % in children and adults, respectively. Children had significantly higher incidence of permanent DI (55.6 %). Radical excision in children (p = 0.000); previous tumour surgery (p = 0.014) and new onset hypopituitarism (p = 0.019) in adults were associated with permanent DI. The triphasic response (23 %), wide intra-day serum sodium fluctuations and hyponatraemia were more common in children. CONCLUSIONS Post-operative DI is a frequent and significant cause of morbidity in children undergoing surgery for CP. Children have a higher incidence of permanent DI. Radical excision is a predictor of permanent DI in children, whereas previous tumour excision and new onset hypopituitarism were predictors of permanent DI among adults. The management of post-operative DI is more difficult in children and the treating physician needs to be alert to detect the triphasic response.
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Affiliation(s)
- Ravindran Pratheesh
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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108
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Ebrahimi A, Honegger J, Schluesener H, Schittenhelm J. Osteonectin Expression in Surrounding Stroma of Craniopharyngiomas. Int J Surg Pathol 2013; 21:591-8. [DOI: 10.1177/1066896913486695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Craniopharyngioma is an epithelial tumor of the sellar region with a high survival rate but a high rate of recurrence, especially in children. Hypothalamic involvement, tumor recurrence, and multiple treatments result in clinical deterioration and impaired quality of life. Using immunohistochemistry, we investigated the expression pattern of osteonectin, a marker of tumor invasion and aggressive behavior, in 43 cases of craniopharyngioma. We observed a positive correlation of osteonectin expression in connective-type stromal tissue surrounding the epithelial tumor cells of craniopharyngioma with the extent of central nervous system infiltration and recurrence rate ( P < .001). Given the previous success of chemotherapeutic agents that target the tumor microenvironment, our findings on osteonectin expression in stroma of craniopharyngiomas might, hopefully, be a guide to find newer prognostic markers capable of estimating the risk of progression or recurrence. They may also aid in the development of therapeutics that target tumor microenvironment to improve patient outcome.
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Affiliation(s)
- Azadeh Ebrahimi
- Division of Immunopathology of the Nervous System
- Graduate School for Cellular and Molecular Neuroscience, University of Tuebingen, Tuebingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | | | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
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109
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Metabolic consequences of craniopharyingioma and their management. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2013; 60:529-34. [PMID: 23538279 DOI: 10.1016/j.endonu.2012.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/18/2012] [Accepted: 11/20/2012] [Indexed: 11/20/2022]
Abstract
Most patients diagnosed with craniopharyngioma survive long-term, but suffer many consequences of the disease and its treatment. Among the metabolic consequences, there is a high prevalence of panhypopituitarism and diabetes insipidus, mainly due to the surgical treatment. Obesity is also more prevalent in these patients than in the general population, and gets worse with time. It is a consequence of a diminished basal metabolic rate and a lower physical activity compared to that of matched controls, with a similar or lower caloric intake. Many different hormonal alterations that could be responsible for those changes in the energy balance have been found. Patients whose tumor involved the hypothalamus are more prone to develop obesity and its consequences. Cardiovascular risk factors are also more prevalent in these patients, leading to a high cardiovascular morbidity and mortality. Sleep disturbances, dysfunction in thermoregulation and thirst and a lower bone mineral density can also be found. Although randomized clinical trials comparing different treatments are lacking, it looks like therapeutic strategies have a minor influence on the risk of long-term sequelae.
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110
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Saleem MA, Hashim ASM, Rashid A, Ali M. Role of gamma knife radiosurgery in multimodality management of craniopharyngioma. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 116:55-60. [PMID: 23417459 DOI: 10.1007/978-3-7091-1376-9_9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This retrospective study evaluated the efficacy and safety of the use of Gamma Knife Radiosurgery (GKS) along with other surgical procedures in the management of craniopharyngioma. METHODS Thirty-five patients (17 children and 18 adults) with craniopharyngioma were treated with GKS between May 2008 and August 2011. The age of the patients ranged from 2 to 53 years (mean 20 years). There were 26 males and 9 females. Craniopharyngiomas were solid in 7 patients, cystic in 4, and mixed in 24. Tumor size ranged from 1 to 33.3 cm(3) (mean 12 cm(3)). The prescription dose ranged from 8 to 14 Gy (mean 11.5 Gy). Maximum dose ranged from 16 to 28 Gy (mean 23 Gy). Before GKS 11 patients underwent subtotal resection of the neoplasm, 2 - neuroendocopic fenestration of the large cystic component, and 10 - stereotactic aspiration of the neoplastic cyst content. RESULTS The length of follow-up period varied from 6 to 36 months (mean 22 months). The tumor response rate and control rate were 77.1 % and 88.5 %, respectively. Clinical outcome was considered excellent in 10 cases, good in 17, fair in 4, and poor in 4. No one patient with normal pituitary function before GKS developed hypopituitarism thereafter. Deterioration of the visual function after treatment was noted in one patient. CONCLUSION After GKS tumor control can be achieved in significant proportion of patients with craniopharyngioma. Treatment-related neurological morbidity in such cases is rare. Therefore, radiosurgery may be considered useful for management of these tumors.
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Affiliation(s)
- M Abid Saleem
- Department of Neurosurgery, Pakistan Gamma Knife and Stereotactic Radiosurgery Center, NeuroSpinal and Medical Institute, 100/1 Mansfield Street, M.A. Jinnah Road, Sadder, Karachi, 74400, Pakistan.
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111
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Masson-Cote L, Masucci GL, Atenafu EG, Millar BA, Cusimano M, Croul S, Mason W, Laperriere NJ, Sahgal A. Long-term outcomes for adult craniopharyngioma following radiation therapy. Acta Oncol 2013; 52:153-8. [PMID: 22568405 DOI: 10.3109/0284186x.2012.685525] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We report long-term outcomes in adult patients with craniopharyngioma following surgery and radiation therapy (RT). MATERIAL AND METHODS Fifty-three patients treated with RT (median, 50 Gy in 25 fractions) between 1980 and 2009 with pathologically confirmed craniopharyngioma were reviewed (53% solid and 47% cystic/solid). The median age was 53 years (range, 22-76), 53% were female, 83% were sub-totally resected, 6% were gross totally resected and 11% had a biopsy and/or cyst aspiration alone. RT was delivered adjuvantly in 53% of patients as opposed to salvage intent upon progression. RESULTS Median follow-up was seven years (86 months, range, 8-259). The 5- and 10-year progression-free survival (PFS) rates were 85% and 69%, overall survival (OS) rates were 76% and 70%, and cause-specific survival (CSS) rates were both 88%, respectively. Both univariable and multivariable analysis identified age (<53 or ≥53) as a prognostic factor for OS (p =0.0003) and CSS (p =0.05). PFS was observed to be worse in patients with >2 surgeries prior to RT (p =0.01). Neither the intent of radiation or tumor type (cystic vs. solid/cystic) were prognostic or predictive. New endocrinopathies and visual dysfunction were observed in 53% and 17% of patients post-surgery, and in 11% and 6% post-RT, respectively. CONCLUSION We report long-term favorable PFS, CSS and OS for craniopharyngioma post-RT. We observe age as a significant prognostic factor, however, timing of radiation was not.
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Affiliation(s)
- Laurence Masson-Cote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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112
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Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 2012; 70:110-23; discussion 123-4. [PMID: 21937943 DOI: 10.1227/neu.0b013e31822e8ffc] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The endoscopic, endonasal, extended transsphenoidal approach is a minimal-access technique for managing craniopharyngiomas. Outcome measures such as return to employment and body mass index (BMI) have not been reported and are necessary for comparison with open transcranial approaches. Most prior reports of the endoscopic, endonasal approach have reported unacceptably high cerebrospinal fluid (CSF) leak rates. OBJECTIVE To assess the outcome of endoscopic, endonasal surgery in a consecutive series of craniopharyngiomas with special attention to extent of resection, CSF leak, return to employment, and BMI. METHODS Twenty-six surgeries were performed on 24 patients at Weill Cornell Medical College-New York Presbyterian Hospital. Five patients had recurrent lesions. Gross-total resection (GTR) was attempted in 21 surgeries. Indications for intended subtotal resection were advanced age, medical comorbidities, preservation of pituitary function, and hypothalamic invasion. RESULTS Mean tumor diameter was 2.9 cm. GTR (18 surgeries) or near-total (>95%) resection (2 surgeries) was achieved in 95% when GTR was the goal. Seven patients received postoperative radiation therapy. Mean follow-up was 35 months with no recurrences in GTR cases and stable disease in all patients at last follow-up. Vision improved in 77%. Diabetes insipidus and panhypopituitarism developed in 42% and 38%, respectively. A more than 9% increase in BMI occurred in 39%; 69% returned to their preoperative profession/schooling. The postoperative CSF leak rate was 3.8%. CONCLUSION Minimal-access, endoscopic, endonasal surgery for craniopharyngioma can achieve high rates of GTR with low rates of CSF leak. Return to employment and obesity rates are comparable to microscope-assisted transcranial and transsphenoidal reports.
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Affiliation(s)
- Lewis Z Leng
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York 10065, USA
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113
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Management of craniopharyngioma: the Liverpool experience following the introduction of the CCLG guidelines. Introducing a new risk assessment grading system. Childs Nerv Syst 2012; 28:1181-92. [PMID: 22570168 DOI: 10.1007/s00381-012-1787-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The Children's Cancer Leukaemia Group (CCLG) proposed a management pathway for craniopharyngioma that advocated limited surgery followed by upfront radiotherapy (RT) for large tumours with hypothalamic involvement and a radical resection only for smaller tumours without hypothalamic involvement. This strategy is not proven to provide optimum care or to be risk-free. The aim of this study is to review our experience of the management of craniopharyngioma diagnosed since the introduction of the CCLG guidelines in 2005. METHODS All children diagnosed with craniopharyngioma at Alder Hey Children's Hospital NHS Foundation Trust in the period between 1 January 2005 and 30 June 2011 were included. Management was based on the presence of hypothalamic syndrome, hydrocephalus, tumour size and radiological Paris grading system. Endoscopic drainage of tumour cyst was performed prior to formalising risk grade and surgical strategy. Definitive surgery was performed in 4-6 weeks time. In this respect, we developed a grading criteria. RESULTS Twenty patients were included. Ten of the children underwent endoscopic cyst drainage prior to definitive surgery. The results of the subsequent surgical excision were complete resection, near total resection or subtotal resection in 30, 25 and 45 % patients, respectively. There was no surgical-related mortality and no new neurological deficits. Nine patients underwent RT at some stage. CONCLUSIONS In this study, we tried to develop an advanced model for the management of craniopharyngioma with a new risk grading system. This may have a direct impact on the surgical strategy and outcome and could be able to improve morbidity.
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114
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Zacharia BE, Bruce SS, Goldstein H, Malone HR, Neugut AI, Bruce JN. Incidence, treatment and survival of patients with craniopharyngioma in the surveillance, epidemiology and end results program. Neuro Oncol 2012; 14:1070-8. [PMID: 22735773 DOI: 10.1093/neuonc/nos142] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Craniopharyngioma is a rare primary central nervous system neoplasm. Our objective was to determine factors associated with incidence, treatment, and survival of craniopharyngiomas in the United States. We used the surveillance, epidemiology and end results program (SEER) database to identify patients who received a diagnosis of craniopharyngioma during 2004-2008. We analyzed clinical and demographic information, including age, race, sex, tumor histology, and treatment. Age-adjusted incidence rates and age, sex, and race-adjusted expected survival rates were calculated. We used Cox proportional hazards models to determine the association between covariates and overall survival. We identified 644 patients with a diagnosis of craniopharyngioma. Black race was associated with an age-adjusted relative risk for craniopharyngioma of 1.26 (95% confidence interval [CI], 0.98-1.59), compared with white race. One- and 3-year survival rates of 91.5% (95% CI, 88.9%-93.5%), and 86.2% (95% CI, 82.7%-89.0%) were observed for the cohort; relative survival rates were 92.1% (95% CI, 89.5%-94.0%) and 87.6% (95% CI, 84.1%-90.4%) for 1- and 3-years, respectively. In the multivariable model, factors associated with prolonged survival included younger age, smaller tumor size, subtotal resection, and radiation therapy. Black race, on the other hand, was associated with worse overall survival in the final model. We demonstrated that >85% of patients survived 3 years after diagnosis and that subtotal resection and radiation therapy were associated with prolonged survival. We also noted a higher incidence rate and worse 1- and 3-year survival rates in the black population. Future investigations should examine these racial disparities and focus on evaluating the efficacy of emerging treatment paradigms.
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Affiliation(s)
- Brad E Zacharia
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
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115
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Kickingereder P, Maarouf M, El Majdoub F, Fuetsch M, Lehrke R, Wirths J, Luyken K, Schomaecker K, Treuer H, Voges J, Sturm V. Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients. J Neurooncol 2012; 109:365-74. [DOI: 10.1007/s11060-012-0902-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
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Higgins DM, Van Gompel JJ, Nippoldt TB, Meyer FB. Symptomatic Rathke cleft cysts: extent of resection and surgical complications. Neurosurg Focus 2012; 31:E2. [PMID: 21721867 DOI: 10.3171/2011.5.focus1175] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Rathke cleft cysts (RCCs) are benign masses arising from the embryological Rathke pouch, and are commonly treated by transsphenoidal surgery. The authors retrospectively compared RCC extent of resection-either gross-total resection (GTR) or decompression-to the primary outcome measure, which was recurrences resulting in repeat surgery, and the secondary outcome measure, which was complications. METHODS Seventy-four patients presenting to the neurosurgical department with RCC were analyzed retrospectively. Sixty-eight patients had a total of 78 surgical procedures, with the diagnosis of RCC confirmed by histological investigation; of these, 61 patients had adequate operative notes for the authors to evaluate extent of resection. Groups were separated into GTR (32 patients) or decompression (subtotal resection or fenestration into the sphenoid sinus; 29 patients) based on operative notes and postoperative imaging. The mean follow-up duration was 60.5 ± 72.1 months (the mean is expressed ± SD throughout). RESULTS The average age at the time of the initial surgery was 42.8 ± 17.4 years, and 70% of patients were female. The mean cyst diameter preoperatively was 16.9 ± 17.8 mm. Eight patients had repeat surgery, our primary outcome measure; 3 repeat operations occurred in the GTR group, and 5 in the decompression group. There was no significant difference in recurrence when comparing groups (GTR 9%, decompression 17%; p = 0.36). There were no major complications; however, analysis of postoperative minor complications revealed that 11 (34%) GTRs resulted in surgical complications, whereas the decompression cohort accounted for only 3 complications (10%) (p = 0.03), with diabetes insipidus (6) and CSF leaks (5) being the most common. Gross-total resection also resulted in an increase in postoperative hyperprolactinemia compared with decompression (p = 0.03). CONCLUSIONS It appears that RCCs require repeat surgery in 13% of cases, and attempted GTR does not appear to reduce the overall rate of recurrence. However, more aggressive resections are associated with more complications in this series.
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The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. J Neurooncol 2012; 108:133-9. [PMID: 22350375 DOI: 10.1007/s11060-012-0806-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/25/2012] [Indexed: 10/14/2022]
Abstract
The purpose of this study is to evaluate the roles of resection extent and adjuvant radiation in the treatment of craniopharyngiomas. We reviewed the records of 122 patients ages 11-52 years who received primary treatment for craniopharyngioma between 1980 and 2009 at the University of California, San Francisco (UCSF). Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were development of panhypopituitarism, diabetes insipidus (DI), and visual field defects. Of 122 patients, 30 (24%) were treated with gross total resection (GTR) without radiation therapy (RT), 3 (3%) with GTR + RT, 41 (33.6%) with subtotal resection (STR) without RT, and 48 (39.3%) with STR + RT. Median age at diagnosis was 30 years, with 46 patients 18 years or younger. Median follow-up for all patients was 56.4 months (interquartile range 18.9-144.2 months) and 47 months (interquartile range 12.3-121.8 months) for the 60 patients without progression. Fifty six patients progressed, 10 have died, 6 without progression. Median PFS was 61.1 months for all patients. PFS rate at 2 years was 61.5% (95% CI: 52.1-70.9). OS rate at 10 years was 91.1% (95% CI 84.3-97.9). There was no significant difference in PFS and OS between patients treated with GTR vs. STR + XRT (PFS; p = 0.544, OS; p = 0.735), but STR alone resulted in significantly shortened PFS compared to STR + RT or GTR (p < 0.001 for both). STR was associated with significantly shortened OS compared to STR + RT (p = 0.050) and trended to shorter OS compared to GTR (p = 0.066). GTR was associated with significantly greater risk of developing DI (56.3 vs. 13.3% with STR + XRT, p < 0.001) and panhypopituitarism (54.8 vs. 26.7% with STR + XRT, p = 0.014). In conclusion, for patients with craniopharyngioma, STR + RT may provide superior clinical outcome, achieving better disease control than STR and limiting side effects associated with aggressive surgical resection.
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118
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Zhao X, Yi X, Wang H, Zhao H. An analysis of related factors of surgical results for patients with craniopharyngiomas. Clin Neurol Neurosurg 2012; 114:149-55. [DOI: 10.1016/j.clineuro.2011.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 07/30/2011] [Accepted: 10/08/2011] [Indexed: 10/15/2022]
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Elliott RE, Jane JA, Wisoff JH. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 2011; 69:630-43; discussion 643. [PMID: 21499159 DOI: 10.1227/neu.0b013e31821a872d] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Controversy persists regarding the optimal treatment of pediatric craniopharyngiomas. OBJECTIVE We performed a meta-analysis of reported series of transcranial (TC) and transsphenoidal (TS) surgery for pediatric craniopharyngiomas to determine whether comparisons between the outcomes in TS and TC approaches are valid. METHODS Online databases were searched for English-language articles reporting quantifiable outcome data published between 1990 and 2010 pertaining to the surgical treatment of pediatric craniopharyngiomas. Forty-eight studies describing 2955 patients having TC surgery and 13 studies describing 373 patients having TS surgery met inclusion criteria. RESULTS Before surgery, patients who had TC surgery had less visual loss, more frequent hydrocephalus and increased intracranial pressure, larger tumors, and more suprasellar disease. After surgery, patients in the TC group had lower rates of gross total resection (GTR), more frequent recurrence after GTR, higher neurological morbidity, more frequent diabetes insipidus, less improvement, and greater deterioration in vision. There was no difference in operative mortality, obesity/hyperphagia, or overall survival percentages. CONCLUSION Directly comparing outcomes after TC and TS surgery for pediatric craniopharyngiomas does not appear to be valid. Baseline differences in patients who underwent each approach create selection bias that may explain the improved rates of disease control and lower morbidity of TS resection. Although TS approaches are becoming increasingly used for smaller tumors and those primarily intrasellar, tumors more amenable to TC surgery include large tumors with significant lateral extension, those that engulf vascular structures, and those with significant peripheral calcification.
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Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University School of Medicine, New York, New York 10016, USA
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120
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2011; 77:329-41. [PMID: 22501020 DOI: 10.1016/j.wneu.2011.07.011] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/09/2011] [Accepted: 07/08/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Craniopharyngiomas have traditionally represented a challenge for open transcranial or transsphenoidal microscopic neurosurgery because of their anatomical location and proximity to vital neurovascular structures. The extended endoscopic endonasal transsphenoidal approach has been more recently developed as a potentially surgically aggressive, yet minimal access, alternative. To gain a more comprehensive assessment of the benefits and limitations of the various approaches to resection of craniopharyngiomas, we performed a systematic review of the available published reports after endoscope-assisted endonasal approaches and compared their results with transsphenoidal purely microscope-based or transcranial microscope-based techniques. METHODS We performed a MEDLINE search of the modern literature (1995-2010) to identify open and endoscopic surgical series for pediatric and adult craniopharyngiomas. Comparisons were made for patient and tumor characteristics as well as extent of resection, morbidity, and visual outcome. Statistical analyses of categorical variables were undertaken by the use of χ(2) and Fisher exact tests with post-hoc Bonferroni analysis to compare endoscopic, microsurgical transsphenoidal, and transcranial approaches. RESULTS Eighty eight studies, involving 3470 patients, were included. The endoscopic cohort had a significantly greater rate of gross total resection (66.9% vs. 48.3%; P < 0.003) and improved visual outcome (56.2% vs. 33.1%; P < 0.003) compared with the open cohort. The transsphenoidal cohort had similar outcomes to the endoscopic group. The rate of cerebrospinal fluid leakage was greater in the endoscopic (18.4%) and transsphenoidal (9.0%) than in the transcranial group (2.6%; P < 0.003), but the transcranial group had a greater rate of seizure (8.5%), which did not occur in the endonasal or transsphenoidal groups (P < 0.003). CONCLUSIONS The endoscopic endonasal approach is a safe and effective alternative for the treatment of certain craniopharyngiomas. Larger lesions with more lateral extension may be more suitable for an open approach, and further follow-up is needed to assess the long-term efficacy of this minimal access approach.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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121
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Jeon C, Kim S, Shin HJ, Nam DH, Lee JI, Park K, Kim JH, Jeon B, Kong DS. The therapeutic efficacy of fractionated radiotherapy and gamma-knife radiosurgery for craniopharyngiomas. J Clin Neurosci 2011; 18:1621-5. [PMID: 22015100 DOI: 10.1016/j.jocn.2011.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/22/2011] [Indexed: 10/16/2022]
Abstract
There is no consensus regarding the optimal timing of radiation treatment (RT) for residual or recurrent craniopharyngioma or the preferred treatment modality between fractionated radiotherapy (FRT) and gamma-knife radiosurgery (GKRS) in terms of morbidity and efficacy. This study aims to clarify the optimal timing of RT for residual or recurrent tumors by analyzing the outcomes of RT as a salvage or adjunctive treatment, and to compare the therapeutic efficacy of FRT and GKRS. Between April 1995 and November 2009, 50 of 129 patients received RT for recurrent or residual tumors. The patients were analyzed for medical data, endocrine outcome, long-term morbidity and mortality rates, recurrence rates, and responses to adjuvant RT and GKRS. Mean progression-free survival was 92.5 months (95% confidence interval, 70.9-114.1 months). Univariate analysis revealed that pre-irradiation tumor volume was closely related to better prognosis (p=0.01). We found that there was no significant difference in recurrence between patients treated with adjuvant compared to salvage RT (p>0.05). Although we found no difference in the efficacy of FRT and GKRS, five patients were newly diagnosed with hypopituitarism following RT. We concluded that RT has a very high rate of tumor control after both adjuvant or salvage RT. This study highlights the relative safety and efficacy of FRT and GKRS.
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Affiliation(s)
- Chiman Jeon
- Pusan National University School of Medicine, Busan, South Korea
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122
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123
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Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Strojan P, Suárez C, Genden EM, Rinaldo A, Ferlito A. Craniopharyngioma: a pathologic, clinical, and surgical review. Head Neck 2011; 34:1036-44. [PMID: 21584897 DOI: 10.1002/hed.21771] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Craniopharyngioma is a rare and mostly benign epithelial tumor of the sellar and suprasellar region. Two principal patterns of craniopharyngioma are recognized: papillary and adamantinomatous. Papillary craniopharyngiomas are encountered in adults and may lack the cystic spaces filled with "motor oil" as well as the palisading peripheral rows of epithelial cells, keratinization, or calcification typical of pediatric adamantinomatous craniopharyngioma. Secondary to their anatomic location, craniopharyngiomas may present with endocrinologic dysfunction and visual disturbances. Differential diagnosis includes Rathke's cleft cyst, pituitary adenoma, dermoid/epidermoid cysts, and other rare sellar/suprasellar lesions as pituicytomas. Many controversies exist concerning the preferred surgical approach for these tumors. Endoscopic endonasal surgery is no longer reserved only for sellar or small cystic suprasellar lesions. Prechiasmatic/preinfundibular lesions are effectively removed using an endonasal transtuberculum/transplanum approach; subchiasmatic/transinfundibular tumors require the addition of a transellar approach with inferior pituitary transposition; and retrochiasmatic/retroinfundibular lesions are better accessed performing an endonasal superior pituitary transposition. Compared with well-established trancranial approaches (pterional, subfrontal, presigmoid), endoscopic endonasal surgery combines the virtues of the caudocranial and midline approaches, allowing for appropriate infrachiasmatic exposure without the need for manipulation of surrounding neurovascular structures to access the tumor. This anatomic advantage, combined with high-definition wide-angle visualization, exquisite endonasal microsurgical techniques, and devoted instrumentation facilitates a high rate of endocrine function preservation and visual improvement, while concurrently achieving comparable resections. Endoscopic skull base reconstruction with the vascularized nasoseptal flap has dramatically reduced the incidence of cerebrospinal fluid leak, consolidating endoscopic endonasal surgery as an effective and safe alternative for the treatment of these challenging tumors.
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Affiliation(s)
- Juan C Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Breil B, Semjonow A, Müller-Tidow C, Fritz F, Dugas M. HIS-based Kaplan-Meier plots--a single source approach for documenting and reusing routine survival information. BMC Med Inform Decis Mak 2011; 11:11. [PMID: 21324182 PMCID: PMC3053219 DOI: 10.1186/1472-6947-11-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 02/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival or outcome information is important for clinical routine as well as for clinical research and should be collected completely, timely and precisely. This information is relevant for multiple usages including quality control, clinical trials, observational studies and epidemiological registries. However, the local hospital information system (HIS) does not support this documentation and therefore this data has to generated by paper based or spreadsheet methods which can result in redundantly documented data. Therefore we investigated, whether integrating the follow-up documentation of different departments in the HIS and reusing it for survival analysis can enable the physician to obtain survival curves in a timely manner and to avoid redundant documentation. METHODS We analysed the current follow-up process of oncological patients in two departments (urology, haematology) with respect to different documentation forms. We developed a concept for comprehensive survival documentation based on a generic data model and implemented a follow-up form within the HIS of the University Hospital Muenster which is suitable for a secondary use of these data. We designed a query to extract the relevant data from the HIS and implemented Kaplan-Meier plots based on these data. To re-use this data sufficient data quality is needed. We measured completeness of forms with respect to all tumour cases in the clinic and completeness of documented items per form as incomplete information can bias results of the survival analysis. RESULTS Based on the form analysis we discovered differences and concordances between both departments. We identified 52 attributes from which 13 were common (e.g. procedures and diagnosis dates) and were used for the generic data model. The electronic follow-up form was integrated in the clinical workflow. Survival data was also retrospectively entered in order to perform survival and quality analyses on a comprehensive data set. Physicians are now able to generate timely Kaplan-Meier plots on current data. We analysed 1029 follow-up forms of 965 patients with survival information between 1992 and 2010. Completeness of forms was 60.2%, completeness of items ranges between 94.3% and 98.5%. Median overall survival time was 16.4 years; median event-free survival time was 7.7 years. CONCLUSION It is feasible to integrate survival information into routine HIS documentation such that Kaplan-Meier plots can be generated directly and in a timely manner.
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Affiliation(s)
- Bernhard Breil
- Department of Medical Informatics, University Muenster, Domagkstraße 9, 48149 Münster, Germany.
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Wang XY, Xu SJ, Li XG. Post-operative implantation metastasis of craniopharyngioma: a case report. J Int Med Res 2011; 38:1876-82. [PMID: 21309505 DOI: 10.1177/147323001003800536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Craniopharyngiomas are histologically benign epithelial tumours arising from squamous epithelial remnants of Rathke's pouch, which have a tendency to invade surrounding structures and recur after apparently complete resection. They represent the most frequent non-glial tumour in children, accounting for approximately 5% of paediatric brain neoplasms. Total resection of a craniopharyngioma may be difficult, and recurrence has been reported in 25-70% of patients. Recurrence often occurs at the primary site, although a few cases of ectopic recurrence along surgical or needle tracts have been reported. Here a case of metastatic adamantinomatous-type craniopharyngioma attributed to direct implantation by surgical procedure is presented, along with a review of the current literature on craniopharyngiomas.
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Affiliation(s)
- X Y Wang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Ji'nan, China
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Liubinas SV, Munshey AS, Kaye AH. Management of recurrent craniopharyngioma. J Clin Neurosci 2011; 18:451-7. [PMID: 21316970 DOI: 10.1016/j.jocn.2010.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 11/18/2022]
Abstract
Craniopharyngioma accounts for approximately 1.2% to 4.6% of all intracranial tumours. Their close proximity to vital structures such as the hypothalamic-pituitary axis and optic apparatus makes them one of the most challenging and controversial management dilemmas in neurosurgery. Recurrence following initial transcranial resection is reported as 9% to 51% at a median time of 26 months to 96 months. Treatment options for recurrent craniopharyngioma include repeat surgery, radiotherapy, radiosurgery and intracystic therapies. We present a series of 54 recurrent craniopharyngiomas treated at The Royal Melbourne Hospital between 1991 and 2008 and discuss the management options now available.
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Affiliation(s)
- Simon V Liubinas
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Sughrue ME, Yang I, Kane AJ, Fang S, Clark AJ, Aranda D, Barani IJ, Parsa AT. Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 2011; 101:463-76. [PMID: 20535527 PMCID: PMC3024496 DOI: 10.1007/s11060-010-0265-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 05/30/2010] [Indexed: 11/24/2022]
Abstract
Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson's chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33-41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ(2) P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05-5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available.
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Affiliation(s)
- Michael E. Sughrue
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Isaac Yang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Ari J. Kane
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Shanna Fang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Aaron J. Clark
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Derrick Aranda
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Igor J. Barani
- Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Andrew T. Parsa
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
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Outcomes of Gamma Knife surgery for craniopharyngiomas. J Neurooncol 2010; 104:305-13. [PMID: 21153860 DOI: 10.1007/s11060-010-0494-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
Gamma Knife surgery (GKS) has emerged as a valuable adjuvant treatment modality for recurrent or residual craniopharyngioma. However, prognostic factors pertaining to progression-free survival (PFS) remain poorly understood. A study was conducted to address this issue. A total of 37 consecutive patients undergoing 39 sessions of GKS procedures targeting the solid portions of the tumors at our institution between 1989 and 2005 were analyzed. Twenty-one male and 16 female patients comprised this study. Median age at GKS was 36 years (range, 4-78). Median tumor volume was 1.6 cm(3) (range, 0.1-18.6), median marginal dose was 14.5 Gy (range, 6-25), and median maximal dose was 30 Gy (range, 15.6-60). Median follow-up was 50 months (range, 8-212). Univariate and multivariate analyses using Cox proportional hazards model were employed to identify the potential prognostic factors including tumor volume, marginal dose, gender, age at GKS, and status of visual field defect (VFD) in terms of in-field PFS. The actuarial 3- and 5-year in-field PFS were 84.8 and 67.0%, respectively. On univariate analysis, absence of VFD at GKS was a favorable prognostic factor (hazard ratio: 0.279; 95% CI, 0.085-0.913, P = 0.035), whereas on multivariate analysis, absence of VFD at GKS, tumor volume ≤1.6 cm(3), and marginal dose >14.5 Gy related to a longer in-field PFS. GKS may offer reasonable control of recurrent or residual craniopharyngiomas. There was a consistent correlation between absence of VFD at the time of GKS and in-field PFS.
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