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Ma J, Chen T, Zhang J, Cao W, Gao G, Yu X, Wang H. Enhanced outcomes in residual or recurrent craniopharyngioma: evaluating combined gamma knife and phosphorus-32 brachytherapy. Clin Transl Oncol 2024:10.1007/s12094-024-03435-2. [PMID: 38488982 DOI: 10.1007/s12094-024-03435-2] [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: 01/03/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Managing residual and recurrent craniopharyngioma effectively is crucial for improving patient outcomes. This study evaluates the combined use of gamma knife and phosphorus-32 brachytherapy, offering insights into alternative, less invasive treatment strategies. METHODS We conducted a retrospective analysis of 97 patients treated from 2010 to 2016 for residual and recurrent craniopharyngioma using gamma knife and phosphorus-32 brachytherapy. We classified these patients into three groups: superficial solid (Group A), simple cystic (Group B), and mixed cystic-solid (Group C). We assessed the treatment's effectiveness by the tumor control rates and evaluated safety by monitoring vision, endocrine function improvements, and complication rates. RESULTS The treatment achieved complete and adequate control rates of 49.5% and 87.6%, respectively. We observed improvements in vision or visual fields in 55.1% of the patients. The morbidity rate was 15.5%. The study found no significant differences in tumor control rates among the various lesion types. CONCLUSION The combination of gamma knife and phosphorus-32 brachytherapy presents a viable, minimally invasive alternative for treating residual and recurrent craniopharyngioma. It offers high tumor control and functional improvement rates, suggesting its potential as a preferred strategy in some instances.
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Affiliation(s)
- Jie Ma
- PLA Medical School, Beijing, 100853, People's Republic of China
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Tao Chen
- State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Jianning Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Weidong Cao
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Gan Gao
- PLA Medical School, Beijing, 100853, People's Republic of China
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
| | - Hongwei Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
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Schmutzer-Sondergeld M, Quach S, Niedermeyer S, Teske N, Ueberschaer M, Schichor C, Kunz M, Thon N. Risk-benefit analysis of surgical treatment strategies for cystic craniopharyngioma in children and adolescents. Front Oncol 2024; 14:1274705. [PMID: 38292926 PMCID: PMC10825040 DOI: 10.3389/fonc.2024.1274705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Objective Treatment strategies for craniopharyngiomas are still under debate particularly for the young population. We here present tumor control and functional outcome data after surgical treatment focusing on stereotactic and microsurgical procedures for cystic craniopharyngiomas in children and adolescents. Methods From our prospective institutional database, we identified all consecutive patients less than 18 years of age who were surgically treated for newly-diagnosed cystic craniopharyngioma between, 2000 and, 2022. Treatment decisions in favor of stereotactic treatment (STX) or microsurgery were made interdisciplinary. STX included aspiration and/or implantation of an internal shunt catheter for permanent cyst drainage. Microsurgery aimed for safe maximal tumor resections. Study endpoints were time to tumor recurrence (TTR) and functional outcome including ophthalmological/perimetric, endocrinological, and body-mass index (BMI) data. Results 29 patients (median age 9.9 yrs, range 4-18 years) were analyzed. According to our interdisciplinary tumor board recommendation, 9 patients underwent stereotactic treatment, 10 patients microsurgical resection, and 10 patients the combination of both. Significant volume reduction was particularly achieved in the stereotactic (p=0.0019) and combined subgroups (p<0.001). Improvement of preoperative visual deficits was always achieved independent of the applied treatment modality. Microsurgery and the combinational treatment were associated with higher rates of postoperative endocrinological dysfunction (p<0.0001) including hypothalamic obesity (median BMI increase from 17.9kg/m2 to 24.1kg/m2, p=0.019). Median follow-up for all patients was 93.9 months (range 3.2-321.5 months). Recurrent tumors were seen in 48.3% and particularly concerned patients after initial combination of surgery and STX (p=0.004). In here, TTR was 35.1 ± 46.9 months. Additional radiation therapy was found indicated in 4 patients to achieve long-lasting tumor control. Conclusion In children and adolescents suffering from predominantly cystic craniopharyngiomas, stereotactic and microsurgical procedures can improve clinical symptoms at low procedural risk. Microsurgery, however, bears a higher risk of postoperative endocrine dysfunction. A risk-adapted surgical treatment concept may have to be applied repeatedly in order to achieve long-term tumor control even without additional irradiation.
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Awad M, Butterfield JT, Dhawan S, Tyler MA, Venteicher AS. Prognostic Factors and Treatment Impact on Overall Survival in Adult Craniopharyngioma. World Neurosurg 2023; 173:e132-e139. [PMID: 36773809 DOI: 10.1016/j.wneu.2023.02.020] [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: 12/13/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To examine the demographics, tumor characteristics, treatments, and clinical outcomes of a large adult craniopharyngioma population. METHODS The 2004-2018 National Cancer Database was queried to investigate adult patients with craniopharyngioma. Univariable and multivariable Cox hazard ratio analysis was conducted to analyze the overall survival (OS) impact of demographic and clinical variables. RESULTS A total of 666 adult patients with craniopharyngioma were identified with a mean age of 51 years (standard deviation 16 years). On multivariable analysis, independent of demographic and clinical variables, increased age, uninsured status, Medicaid, Medicare, Charlson-Deyo Comorbidity Index of 2, and tumor size greater than 40 mm were independently associated with worse OS. There was no significant difference in survival between histologic subtypes. Gross total resection (GTR) (hazard ratio [HR] 0.602, 95% confidence interval [CI] 0.384-0.942, P = 0.026) and subtotal resection (STR) with adjuvant radiotherapy (HR 0.316, 95% CI 0.140-0.710, P = 0.005) were independently associated with improved OS. GTR with radiotherapy trended towards improved OS (HR 0.601, 95% CI 0.334-1.083, P =0.090), but STR alone and radiotherapy alone demonstrated no significant difference in survival compared with no treatment on multivariable analysis. Kaplan-Meier survival models demonstrated improved survival with GTR, GTR + radiation therapy, and STR + radiation therapy. Patients undergoing endoscopic resection had significantly lower GTR rates and greater rates of adjuvant radiotherapy compared with open approaches but no difference in OS. CONCLUSION Adult patients with craniopharyngioma who underwent GTR or STR with adjuvant radiotherapy had significantly improved overall survival. Endoscopic approaches had lower rates of GTR but no difference in OS.
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Affiliation(s)
- Matthew Awad
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John T Butterfield
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew A Tyler
- Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA; Department of Otolaryngology- Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Serbis A, Tsinopoulou VR, Papadopoulou A, Kolanis S, Sakellari EI, Margaritis K, Litou E, Ntouma S, Giza S, Kotanidou EP, Galli-Tsinopoulou A. Predictive Factors for Pediatric Craniopharyngioma Recurrence: An Extensive Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13091588. [PMID: 37174978 PMCID: PMC10177772 DOI: 10.3390/diagnostics13091588] [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: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Despite being classified as benign tumors, craniopharyngiomas (CPs) are associated with significant morbidity and mortality due to their location, growth pattern, and tendency to recur. Two types can be identified depending on age distribution, morphology, and growth pattern, adamantinomatous and papillary. The adamantinomatous CP is one of the most frequently encountered central nervous system tumors in childhood. Our aim was to review the relevant literature to identify clinical, morphological, and immunohistochemical prognostic factors that have been implicated in childhood-onset CP recurrence. Lack of radical surgical removal of the primary tumor by an experienced neurosurgical team and radiotherapy after a subtotal excision has been proven to significantly increase the recurrence rate of CP. Other risk factors that have been consistently recognized in the literature include younger age at diagnosis (especially <5 years), larger tumor size at presentation, cystic appearance, difficult tumor location, and tight adherence to surrounding structures, as well as the histological presence of whorl-like arrays. In addition, several other risk factors have been studied, albeit with conflicting results, especially in the pediatric population. Identifying risk factors for CP recurrence is of utmost importance for the successful management of these patients in order to ultimately ensure the best prognosis.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, School of Medicine, University of Ioannina, St. Niarhcos Avenue, 45500 Ioannina, Greece
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Vasiliki Rengina Tsinopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Anastasia Papadopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Savvas Kolanis
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Eleni I Sakellari
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Kosmas Margaritis
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Eleni Litou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Stergianna Ntouma
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Styliani Giza
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Eleni P Kotanidou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
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Shi X, Wang L, Wu B, Zhang Y, Zhou Z. Long-term outcomes after a transcranial microsurgical approach to craniopharyngiomas: a 20-year clinical follow-up study. Neurosurg Rev 2023; 46:34. [PMID: 36622450 DOI: 10.1007/s10143-022-01942-w] [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: 08/28/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/10/2023]
Abstract
Craniopharyngioma (CP) is a mostly benign tumor that is nonetheless one of most formidable skull base lesions. CP tends to recur, and scarce clinical results are available regarding its long-term outcomes. From February 1996 to April 2002, craniopharyngiomas primarily resected by open surgery in a single-center and single-surgeon practice were screened. Medical information regarding patients' baseline, tumor parameters, endocrinological results, complications, and quality of life in those patients with a follow-up longer than 20 years were reviewed. Nineteen out of 187 patients who met the inclusion criteria were eligible, and 78.9% of the patients were admitted due to visual deficits. The transcranial approach was mostly applied for the first attempt of opening resection, with 94.7% gross total resection. The size of the tumor ranged from 25 to 45 mm with a mean maximal diameter of 34.7 mm. Although 7 out of 19 patients received an extra procedure, 6 patients (31.5%) regained fertility, with 3 women bearing a total of 5 children and 3 men fathering a total of 4 children, during the 21.4-year follow-up (range: 20.0-23.3 years). The mean Karnofsky Performance Status (KPS) score was 97.9 (range: 80-100) at the last follow-up, and the physical and mental 36-Item Short Form Health Survey (SF-36) scores were 88.0 and 80.5, respectively. The tumor sizes of the patients who regained fertility were not significantly different from those of the patients who remained infertile (t = 1.29, P > 0.2). The time interval from prior surgery to tumor resection for recurrent cases ranged from 0.3 to 17.4 years (mean, 7.3 years). There was no significant difference in the time until tumor recurrence in the patients who underwent a second surgery, a third surgery, or a fourth surgery. The satisfactory results in the present study revealed favorable long-term outcomes following the transcranial management of CPs, with acceptable endocrinological function and tumor-free survival. A decisive policy of open surgery with the objective of radical tumor removal remains a valid method for the primary treatment of CPs, aiming to avoid retreatment after tumor recurrence involving vital hypothalamic structures or hydrocephalus.
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Affiliation(s)
- Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China.
| | - Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Bin Wu
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Yongli Zhang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhongqing Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
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Piloni M, Gagliardi F, Bailo M, Losa M, Boari N, Spina A, Mortini P. Craniopharyngioma in Pediatrics and Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:299-329. [PMID: 37452943 DOI: 10.1007/978-3-031-23705-8_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Craniopharyngiomas are rare malignancies of dysembryogenic origin, involving the sellar and parasellar areas. These low-grade, epithelial tumors account for two main histological patterns (adamantinomatous craniopharyngioma and papillary craniopharyngioma), which differ in epidemiology, pathogenesis, and histomorphological appearance. Adamantinomatous craniopharyngiomas typically show a bimodal age distribution (5-15 years and 45-60 years), while papillary craniopharyngiomas are limited to adult patients, especially in the fifth and sixth decades of life. Recently, craniopharyngioma histological subtypes have been demonstrated to harbor distinct biomolecular signatures. Somatic mutations in CTNNB1 gene encoding β-catenin have been exclusively detected in adamantinomatous craniopharyngiomas, which predominantly manifest as cystic lesions, while papillary craniopharyngiomas are driven by BRAF V600E mutations in up to 95% of cases and are typically solid masses. Despite the benign histological nature (grade I according to the World Health Organization classification), craniopharyngiomas may heavily affect long-term survival and quality of life, due to their growth pattern in a critical region for the presence of eloquent neurovascular structures and possible neurological sequelae following their treatment. Clinical manifestations are mostly related to the involvement of hypothalamic-pituitary axis, optic pathways, ventricular system, and major blood vessels of the circle of Willis. Symptoms and signs referable to intracranial hypertension, visual disturbance, and endocrine deficiencies should promptly raise the clinical suspicion for sellar and suprasellar pathologies, advocating further neuroimaging investigations, especially brain MRI. The optimal therapeutic management of craniopharyngiomas is still a matter of debate. Over the last decades, the surgical strategy for craniopharyngiomas, especially in younger patients, has shifted from the aggressive attempt of radical resection to a more conservative and individualized approach via a planned subtotal resection followed by adjuvant radiotherapy, aimed at preserving functional outcomes and minimizing surgery-related morbidity. Whenever gross total removal is not safely feasible, adjuvant radiotherapy (RT) and stereotactic radiosurgery (SRS) have gained an increasingly important role to manage tumor residual or recurrence. The role of intracavitary therapies, including antineoplastic drugs or sealed radioactive sources, is predominantly limited to monocystic craniopharyngiomas as secondary therapeutic option. Novel findings in genetic profiling of craniopharyngiomas have unfold new scenarios in the development of targeted therapies based on brand-new biomolecular markers, advancing the hypothesis of introducing neoadjuvant chemotherapy regimens in order to reduce tumor burden prior to resection. Indeed, the rarity of these neoplasms requires a multispecialty approach involving an expert team of endocrinologists, neurosurgeons, neuro-ophthalmologists, neuroradiologists, radiotherapists, and neuro-oncologists, in order to pursue a significant impact on postoperative outcomes and long-term prognosis.
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Affiliation(s)
- Martina Piloni
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Gao Q, Luo J, Pan J, Zhang L, Song D, Zhang M, Xu D, Guo F. Integrative analyses identify HIF-1α as a potential protective role with immune cell infiltration in adamantinomatous craniopharyngioma. Front Immunol 2022; 13:949509. [PMID: 36091021 PMCID: PMC9450013 DOI: 10.3389/fimmu.2022.949509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Craniopharyngiomas (CPs) are histologically benign tumors located in the sellar–suprasellar region. Although the transcriptome development in recent years have deepened our knowledge to the tumorigenesis process of adamantinomatous craniopharyngioma (ACP), the peritumoral immune infiltration of tumor is still not well understood. In this study, weighted gene coexpression network analysis (WGCNA) was applied to identify different gene modules based on clinical characteristics and gene expression, and then, the protein–protein interaction (PPI) network with the Cytohubba plug-in were performed to screen pivotal genes. In addition, immune cell infiltration (ICI) analysis was used to evaluate the immune microenvironment of ACP patients. In total, 8,568 differential expression genes were identified based on our datasets and two microarray profiles from the public database. The functional enrichment analysis revealed that upregulated genes were mainly enriched in immune-related pathways while downregulated genes were shown in the hormone and transduction of signaling pathways. The WGCNA investigated the most relevant modules, and 1,858 hub genes was detected, from which the PPI network identified 14 pivotal genes, and the Hypoxia-inducible factor 1-alpha (HIF-1α) pathway including four critical genes may be involved in the development of ACP. Moreover, naïve CD4+ and CD8+ T cells were decreased while specific subtypes of T cells were significantly increased in ACP patients according to ICI analysis. Validation by immunofluorescence staining revealed a higher expression of HIF-1α in ACP (ACP vs. control) and adult-subtype (adult vs. children), suggesting a possible state of immune system activation. Notably, children with low HIF-1α scores were related to the hypothalamus involvement and hydrocephalus symptoms. In this study, we successfully identified HIF-1α as a key role in the tumorigenesis and development of ACP through comprehensive integrated analyses and systematically investigated the potential relationship with immune cells in ACP. The results may provide valuable resources for understanding the underlying mechanisms of ACP and strengthen HIF-1α as a potential immunotherapeutic target in clinical application.
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Affiliation(s)
- Qiang Gao
- School of Medicine, Tsinghua University, Beijing, China
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jing Luo
- School of Medicine, Tsinghua University, Beijing, China
- Department of Rheumatology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jingjing Pan
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dengpan Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingchu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingkang Xu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- *Correspondence: Dingkang Xu, ; Fuyou Guo,
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Dingkang Xu, ; Fuyou Guo,
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Nie C, Ye Y, Wu J, Zhao H, Jiang X, Wang H. Clinical Outcomes of Transcranial and Endoscopic Endonasal Surgery for Craniopharyngiomas: A Single-Institution Experience. Front Oncol 2022; 12:755342. [PMID: 35223463 PMCID: PMC8866852 DOI: 10.3389/fonc.2022.755342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Craniopharyngioma has always been a challenge for the neurosurgeon, and there is no consensus on optimal treatment. The objective of this study was to compare surgical outcomes and complications between transcranial surgery (TCS) and endoscopic endonasal surgery (EES) of craniopharyngiomas. Methods A retrospective review of patients who underwent craniopharyngioma resection at Wuhan Union Hospital between January 2010 and December 2019 was performed. A total of 273 patients were enrolled in this retrospective study. All patients were analyzed with surgical effects, endocrinologic outcomes, complications, and follow-up results. Results A total of 185 patients underwent TCS and 88 underwent EES. There were no significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between the two groups. The mean follow-up was 30.5 months (range 8–51 months). The EES group had a greater gross total resection (GTR) rate (89.8% EES vs. 77.3% TCS, p < 0.05) and lower rate of hypopituitarism (53.4% EES vs. 68.1% TCS, p < 0.05) and diabetes insipidus (DI) (51.1% EES vs. 72.4% TCS, p < 0.05). More postoperative cerebrospinal fluid (CSF) leaks occurred in the EES group (4.5% EES vs. 0% TCS, p < 0.05). More patients in the EES group with preoperative visual deficits experienced improvement after surgery (74.5% EES vs. 56.3% TCS, p < 0.05). There were statistical differences in the recurrence rates (12.5% EES vs. 23.8% TCS, p < 0.05) between the 2 groups. Conclusion These data support the view that EES is a safe and effective minimally invasive surgery compared to TCS. Compared to TCS, EES has fewer surgical complications and a lower recurrence rate.
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Affiliation(s)
- Chuansheng Nie
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youfan Ye
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingnan Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haijun Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gallotti AL, Barzaghi LR, Albano L, Medone M, Gagliardi F, Losa M, Mortini P. Comparison between extended transsphenoidal and transcranial surgery for craniopharyngioma: focus on hypothalamic function and obesity. Pituitary 2022; 25:74-84. [PMID: 34236593 DOI: 10.1007/s11102-021-01171-2] [Citation(s) in RCA: 2] [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] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients suffering from craniopharyngiomas currently have good survival rates, but long-term sequelae, such as development of obesity, worsen their quality of life. Optimal treatment is still controversial and changed during the decades, becoming less aggressive. Transcranial (TC) surgery was the first approach to be used, followed by extended transsphenoidal (eTNS) access. This study aims to compare the two approaches in terms of risk of hypothalamic damage leading to obesity. METHODS This is a monocentric retrospective analysis of post-puberal patients treated for primary craniopharyngioma. Postoperative obesity and percentual postsurgical BMI variation were considered proxy for hypothalamic function and used to fit regression models with basal BMI, type of surgery, tumor volume and hypothalamic involvement (anterior vs. anteroposterior). RESULTS No difference in radicality was observed between the two approaches; eTNS was more effective in ameliorating visual function but was significantly associated with CSF leaks. The TC approach was associated with a higher incidence of diabetes insipidus. Regression analysis showed only tumor volume and basal BMI resulted as independent predictors for both postoperative obesity (respectively, OR 1.15, P = 0.041, and OR 1.57, P < 0.001) and percentual BMI variation (respectively, + 0.92%, P = 0.005, and - 1.49%, P = 0.001). CONCLUSIONS Larger lesions portend a higher risk to develop postoperative obesity, independently of hypothalamic involvement. Interestingly, basal BMI is independent of lesional volume and is associated with postoperative obesity, but lesser postoperative BMI variation. The surgical approach does not influence the obesity risk. However, eTNS proves valid in managing large tumors with important hypothalamic invasion.
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Affiliation(s)
- Alberto Luigi Gallotti
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Marzia Medone
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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10
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Di Somma C, Scarano E, Barrea L, Solari D, Riccio E, Arianna R, Cavallo LM, Romano F, Di Benedetto E, Rodriguez A, de Alteriis G, Colao A. Craniopharyngioma, Chronotypes and Metabolic Risk Profile. Nutrients 2021; 13:nu13103444. [PMID: 34684445 PMCID: PMC8538918 DOI: 10.3390/nu13103444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Aim: To investigate the potential association among Craniopharyngioma (CP), chronotypes and metabolic risk profile. Subjects and Methods: The study population included 28 patients (46.4% males; 42.6 ± 15.8 years) and 28 controls, age, gender and BMI matched (46.4% males; 46.5 ± 12.9 years). In this study sample, we evaluated: anthropometric measurements (waist circumference, WC; BMI), plasma glucose, lipid profile, and systolic (SBP) and diastolic (DBP) blood pressure. Morningness-Eveningness was measured with the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ), which included 19 questions about preferred sleep time and daily performance. Results: in both patients and controls grade I obesity was detected in 15 subjects (53.6%), grade II obesity in 13 subjects (46.4%). In the patient group, the mean score of chronotype was 47.8 ± 12.6. In particular, 9 patients (32.1%) exhibited the morning chronotype, 6 (21.4%) the intermediate chronotype and 13 (46.4.%) the evening chronotype. No significant difference was found in gender and age among the chronotype categories. Patients with the evening chronotype had higher blood pressure values and worse metabolic parameters than those with the morning chronotype. In the control group, the mean score of the chronotype was 57.6 ± 9.5. In particular, 16 (57.1%) subjects exhibited the morning chronotype, 10 (35.7%) the intermediate chronotype and only 2 (7.1.%) the evening chronotype. The prevalence of intermediate and evening chronotypes was higher in females than males (p = 0.021), while males have a higher prevalence of the morning chronotype. Subjects with intermediate and evening chronotypes had worse metabolic parameters than those with the morning chronotype. In patients, the chronotype score was inversely correlated to WC, BMI, SBP, DBP, plasma glucose, total cholesterol, triglycerides, LDL cholesterol and positively correlated with HDL cholesterol. No correlation was found between age and chronotype. In controls, the chronotype score was inversely correlated to WC, BMI, plasma glucose, total cholesterol, LDL cholesterol. No correlation was found among chronotype and age, blood pressure, triglycerides, HDL cholesterol. Considering the whole population of the study (patients and controls), at logistic regression the chronotype score was significantly associated with the presence of CP. Conclusions: for the first time thus far, our study puts the light on the association of the CP with chronotypes and metabolic alterations in this disease, which are the main determinants of the reduced quality of life, higher morbidity and mortality in this setting of patients. This finding suggests that alterations of chronotype might represent an adjunctive risk for CP patients and a possible target for their integrate management.
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Affiliation(s)
- Carolina Di Somma
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-3779
| | - Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Enrico Riccio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Rossana Arianna
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Fiammetta Romano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Elea Di Benedetto
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Alice Rodriguez
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Giulia de Alteriis
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
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11
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Xu D, Wei Q, Li Z, Hu Y, Hu P, Zhao S, Song D, Lei S, Zhang M, Gao Q, Zhang L, Lin F, Zuo Y, Liu X, Feng M, Ma C, Guo F. Development and Validation of Predicting Nomograms for Craniopharyngioma: A Retrospective, Multiple-Center, Cohort Study. Front Oncol 2021; 11:691288. [PMID: 34322389 PMCID: PMC8312552 DOI: 10.3389/fonc.2021.691288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Craniopharyngiomas (CPs) are benign tumors arising from the sellar region. However, little is known about their clinical features and long-term recurrence due to low morbidity and the lack of large cohort studies. Thus, we aimed to develop nomograms to accurately predict the extent of resection and tumor recurrence using clinical parameters. A total of 545 patients diagnosed with CP between 2009 and 2019 were examined: 381 in the development cohort and 164 in the validation cohort. Least absolute shrinkage and selection operator (LASSO) and Cox regression analyses were performed to establish two nomograms. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and Kaplan-Meier (KM) curves were used to evaluate their predictive performance and discriminative power, respectively, in the two cohorts. In addition, the EORTC QLQ-BN20 questionnaire was used to assess neuropsychological status in the follow-up. In the development cohort, the area under the curve (AUC) and C-index were 0.760 and 0.758, respectively, for predicting the extent of resection and 0.78 and 0.75, respectively, for predicting 3-year progression-free survival (PFS) and 5-year PFS. Additionally, the model had a predictive accuracy of 0.785. Both nomograms showed acceptable discrimination in the two cohorts. Moreover, DCA demonstrated excellent clinical benefits from the two nomograms. Finally, participants were classified into two distinct risk groups according to the risk score, and an online calculator was created for convenient clinical use. During long term follow-up, hypothyroidism (77.61%) and hypocortisolism (76.70%) were the most common endocrine dysfunction after surgery and significant deficits were observed concerning visual disorder, motor dysfunction and seizures in the recurrent groups. In particular, better quality of life was associated with gross total resection (GTR), postoperative radiation, anterior interhemispheric (AI) approach and transsphenoidal approach. To our knowledge, these are the first nomograms based on a very large cohort of patients with CP that show potential benefits for guiding treatment decisions and long-term surveillance. The current study demonstrated the online calculator serve as the practical tool for individual strategies based on the patient’s baseline characteristics to achieve a better prognosis.
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Affiliation(s)
- Dingkang Xu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingjie Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Li
- The Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Hu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peizhu Hu
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shengqi Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dengpan Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shixiong Lei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingchu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangbo Lin
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchao Zuo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhao Feng
- Department of Neurosurgery, The Third Affiliated Hospital, Zheou University, Zhengzhou, China
| | - Chunxiao Ma
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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12
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Hasegawa H, Jentoft ME, Young WF, Lakomkin N, Van Gompel JJ, Link MJ, Atkinson JL, Meyer FB. Collision of Craniopharyngioma and Pituitary Adenoma: Comprehensive Review of an Extremely Rare Sellar Condition. World Neurosurg 2021; 149:e51-e62. [PMID: 33647491 DOI: 10.1016/j.wneu.2021.02.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The collision of pituitary adenoma and craniopharyngioma is extremely rare and thus there remains a paucity of data. METHODS We described a patient from our institution. We also performed a systematic review and subsequent quantitative synthesis of the literature (n = 21) and our institutional case to yield an integrated cohort, and a descriptive analysis was carried out. RESULTS Twenty-two patients (15 males and 7 females) were included in the integrated cohort. The median age was 47.0 years (range, 8-75 years). The tumor subtypes were 5 somatotropic, 5 lactotropic, 4 nonfunctioning, 3 gonadotropic, 2 corticotropic, 1 plurihormonal, and 1 silent subtype 3 for pituitary adenomas, and 19 adamantinomatous, 2 papillary, and 1 unknown subtype for craniopharyngiomas. Three different radiographic patterns were observed: solid mass with cystic component (n = 5), coexistence of two distinct solid components (n = 3), and a mixed-intensity solid mass (n = 5). The first 2 were consistent with histologically separate collision, whereas the third was consistent with histologically admixed collision. Among 19 patients in whom the postoperative course was recorded, a secondary intervention was required in 14 (73.7%) because of tumor progression or residual. The recurrence rate after gross total resection was 33.3%. Postoperative hormone replacement was required in 33.3%. The 10-year cumulative overall survival was 73.1%. CONCLUSIONS Most craniopharyngiomas were adamantinomatous. There are 2 types of collisions: separated and admixed. Tumor control, overall survival, and endocrinologic remission are more challenging to achieve than for solitary tumors, but gross total resection of both tumors is important for satisfactory tumor control.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Mark E Jentoft
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John L Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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13
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Zamanipoor Najafabadi AH, Genders SW, van Furth WR. Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis. Acta Neurochir (Wien) 2021; 163:73-82. [PMID: 32888075 PMCID: PMC7778613 DOI: 10.1007/s00701-020-04554-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
ABTRACT BACKGROUND: Most spheno-orbital meningioma series span multiple decades, and predictors of visual outcomes have not yet been systemically assessed. We describe visual outcomes in a recent cohort and assess predictors of postoperative visual outcomes. METHODS Consecutive case series operated by a team of a neurosurgeon and orbital surgeon between May 2015 and January 2019. Best corrected visual acuity (BCVA), visual fields (static perimetry), and relative proptosis were measured preoperatively and postoperatively at 3/6/12 months after which it was assessed yearly. Predictors were assessed with linear regression analysis. RESULTS Nineteen patients (all WHO grade I) were operated by the pterional approach (median follow-up 2.4 years). Preoperative visual acuity deficits (n = 10) normalized in 70% and improved in 10% (median preoperative: 0.8, postoperative: 1.2, p = 0.021). Preoperative visual field deficits (n = 8) normalized in all patients (preoperative: - 6.5 dB, postoperative: - 1.5 dB, p = 0.008). Preoperative proptosis (n = 16) normalized in 44% and improved in 56% (preoperative: 5 mm, postoperative: 2 mm, p < 0.001). BCVA and visual fields remained stable at longer follow-up in 95% of patients, while 21% showed progression of proptosis. Predictors for worse longer-term (> 12 months) BCVA were worse preoperative BCVA (p = 0.002) and diagnosis of multiple meningioma (p = 0.021). Predictors for worse longer-term visual fields were higher diameter of hyperostosis (p = 0.009) and higher Simpson grade (p = 0.032). Predictor for short-term (3 months) proptosis was preoperative proptosis (p = 0.006). CONCLUSION We recommend surgery, even of patients with minimal visual impairment or hyperostosis, as patients who present with deteriorated visual function or extensive hyperostosis are less likely to have postoperative visual outcomes restored to normal.
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Affiliation(s)
| | - Stijn W Genders
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Wouter R van Furth
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
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14
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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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15
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Multifactor Prognostic Evaluation of Postoperative Craniopharyngiomas. J Craniofac Surg 2020; 32:228-232. [PMID: 33186284 DOI: 10.1097/scs.0000000000006910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate various factors that could be associated with the postoperative prognosis of patients with craniopharyngiomas and provide evidence for the proper surgical course and optimal outcome assessments of craniopharyngiomas. METHODS We performed a retrospective study and reviewed 68 patients with craniopharyngiomas who received surgery from May 2013 to October 2018. The relationships between the disease prognosis and age, gender, onset symptoms, size of tumor, degree of calcification, consistency, QST classification, adhesion strength, and pathological types were analyzed. RESULTS There were no significant associations between the prognosis and age, gender, number of onset symptoms, and pathological types (P > 0.05). The severity of onset symptoms, tumor diameter, and degree of calcification was significantly associated with the prognosis (P < 0.05). There were significant different prognoses between patients with cystic and solid, mixed tumors (P < 0.05). The prognosis of patients with T type tumors was different from that of patients with either Q or S type tumors (P < 0.05). The prognoses of patients with either loose or tight type tumors were significantly different from those of patients with either invasive or fusion type tumors (P < 0.05). CONCLUSION Clinical and pathological variables, such as onset symptoms, size of tumor, degree of calcification, consistency, QST classification, and the degree of adhesion strength, were important factors in evaluating the prognosis of patients with craniopharyngiomas.
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16
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Wu A. Overview of Modern Surgical Management of Central Nervous System Tumors: North American Experience. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666190212112842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A wide variety of neoplasms can affect the central nervous system. Surgical management
is impacted by tumor biology and anatomic location. In this review, an overview is presented
of common and clinically significant CNS tumor types based on anatomic location.
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Affiliation(s)
- Adam Wu
- University of Saskatchewan, Saskatoon, Saskatchewan, SK, Canada
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17
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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: 2] [Impact Index Per Article: 0.5] [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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18
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Greenberger BA, Yock TI. The role of proton therapy in pediatric malignancies: Recent advances and future directions. Semin Oncol 2020; 47:8-22. [PMID: 32139101 DOI: 10.1053/j.seminoncol.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
Proton radiotherapy has promised an advantage in safely treating pediatric malignancies with an increased capability to spare normal tissues, reducing the risk of both acute and late toxicity. The past decade has seen the proliferation of more than 30 proton facilities in the United States, with increased capacity to provide access to approximately 3,000 children per year who will require radiotherapy for their disease. We provide a review of the initial efforts to describe outcomes after proton therapy across the common pediatric disease sites. We discuss the main attempts to assess comparative efficacy between proton and photon radiotherapy concerning toxicity. We also discuss recent efforts of multi-institutional registries aimed at accelerating research to better define the optimal treatment paradigm for children requiring radiotherapy for cure.
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Affiliation(s)
- Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Francis H. Burr Proton Therapy Center, Boston, MA.
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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: 11] [Impact Index Per Article: 2.8] [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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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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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. [DOI: 10.3171/2018.3.jns172528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe 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.METHODSBetween 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.RESULTSThe 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.CONCLUSIONSThese 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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Hayashi Y, Sasagawa Y, Oishi M, Misaki K, Kozaka K, Tachibana O, Nakada M. Radiological and endocrinological evaluations with grading of hypothalamic perifocal edema caused by craniopharyngiomas. Pituitary 2019; 22:146-155. [PMID: 30847775 DOI: 10.1007/s11102-019-00945-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypophysial and hypothalamic dysfunction caused by craniopharyngioma is a serious problem despite the progress of surgical approaches and techniques. Perifocal edema induced by craniopharyngioma could be speculated as a potential factor resulting in pre- and post-operative hypophysial and hypothalamic dysfunction, as well as, their anatomical involvement. METHODS Medical records of 54 patients with craniopharyngioma were retrospectively reviewed. The edema was characterized by a hyperintense area in magnetic resonance imaging, being classified into no edema (group A), only adjacent to the tumor (group B), and extending to the internal capsule or the optic tract (group C). Age, sex, tumor diameter, presence of cyst, hydrocephalus, intracranial pressure (ICP) elevation, visual function impairment, hypopituitarism, diabetes insipidus, memory disturbance, and obesity were investigated. RESULTS The occurrence rate of edema was found more frequently in adults (73.7%) than in children (25.0%). The peritumoral edema grading system had an excellent correlation with the degree of hypothalamic involvement graded by the Puget's system. Pre-operative ICP elevation was significantly detected in group C when compared with the other groups. In adults patients, group C was significantly associated with the occurrence of hydrocephalus both in pre- and post-operatively. Pre- and post-operative hypothalamic dysfunction, including diabetes insipidus, memory disturbance, and obesity, were highest in group C. CONCLUSION Hypothalamic dysfunctions greatly influence the quality of daily living following craniopharyngioma surgery. The grading of perifocal edema's extension could be a new index suggesting pre- and post-operative hypothalamic dysfunction caused by craniopharyngioma in addition to their anatomical involvement.
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Affiliation(s)
- Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Effects of craniopharyngioma cyst fluid on neurons and glial cells cultured from rat brain hypothalamus. J Chem Neuroanat 2018; 94:93-101. [PMID: 30339791 DOI: 10.1016/j.jchemneu.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022]
Abstract
Craniopharyngiomas (CPs) are rare, epithelial tumors of the central nervous system (CNS) that could lead to manifestation of multiple post-operative symptoms, ranging from hormonal imbalance to obesity, diabetes, visual, neurological and neurocognitive impairments. CP is more frequent in children, and has been reported in middle aged adults as well. In fact, arterial laceration and/or brain stroke which may occur following the removal of some CPs is mainly due to calcification of that CPs along with strong attachments to the blood vessels. The dense oily fluid content of CPs is reported to cause brain tissue damage, demyelination and axonal loss in the hypothalamus; however, its exact effect on different cell types of CNS is still unexplored. In this study, we have collected CP cyst fluid (CCF) from mostly young patients during surgical removal and exposed it 9-10 days in vitro to the primary cultures derived from rat brain hypothalamus for 48 h. A gradual decline in cell viability was noted with increasing concentration of CCF. Moreover, a distinct degenerative morphological transformation was observed in neurons and glial cells, including appearance of blebbing and overall reduction of the cell volume. Further, enhanced expression of Caspase-3 in neurons and glial cells exposed to CCF by immunofluorescence imaging, supported by Western blot experiment suggest CCF induced apoptosis of hypothalamic cells in culture. In this study, we have demonstrated the deleterious effects of the cyst fluid on various cell types within the tumors originating region of the brain and its surroundings for the first time. Taken together, this finding could be beneficial towards identifying the region specific toxic effects of the cyst fluid and its underlying mechanism.
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Losa M, Pieri V, Bailo M, Gagliardi F, Barzaghi LR, Gioia L, Del Vecchio A, Bolognesi A, Mortini P. Single fraction and multisession Gamma Knife radiosurgery for craniopharyngioma. Pituitary 2018; 21:499-506. [PMID: 30043097 DOI: 10.1007/s11102-018-0903-5] [Citation(s) in RCA: 20] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE The optimal management of residual or recurring craniopharyngioma is still a matter of debate even though adjuvant radiation therapy plays a crucial role. Aim of our study is to report the results of single fraction or multisession Gamma Knife radiosurgery (GKRS) in patients with craniopharyngioma. METHODS We included 50 consecutive patients treated from 1994 to 2016. All patients had at least one post GKRS magnetic resonance imaging reviewed at our center. Vital status of all patients was assessed at the end of 2016. RESULTS There were 29 males (58.0%) and 21 females (42.0%). Mean age was 41.5 ± 2.8 year. Single session GKRS was delivered in 29 patients (58.0%). The mean tumor volume was 2.15 ± 0.3 cm3 and the mean prescription dose to the tumor margin was 14.3 ± 0.3 Gy. During a mean follow-up of 74.6 ± 8.4 months, seven patients (14.0%) had recurrence of disease. The 5- and 10-year recurrence-free survivals were 90.3% (95% CI, 81.0-99.6%) and 78.4% (95% CI, 59.9-96.9%), respectively. Multisession GKRS was not less effective than single fraction GKRS. Eighteen of the 28 patients (64.3%) had a tumor volume decrease of at least 10%. No serious side effects occurred after GKRS treatment, except for one case of mild visual worsening. CONCLUSIONS GKRS was effective for controlling the growth of residual or recurrent craniopharyngioma. Serious side effects were uncommon. Multisession GKRS seems a very promising tool to allow performing GKRS even in patients with large residual or recurrent craniopharyngioma.
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Affiliation(s)
- Marco Losa
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy.
| | - Valentina Pieri
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Michele Bailo
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Lorenzo Gioia
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics Department, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Angelo Bolognesi
- Department of Radiotherapy, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
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Feng SY, Zhang YY, Yu XG, Chen XL, Zhou T, Bu B, Jiang JL. Microsurgical treatment of craniopharyngioma: Experiences on 183 consecutive patients. Medicine (Baltimore) 2018; 97:e11746. [PMID: 30142761 PMCID: PMC6112966 DOI: 10.1097/md.0000000000011746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aimed to summarize the clinical experiences and postoperative effects of microsurgical approaches for craniopharyngioma.A total of 183 craniopharyngioma patients who underwent microsurgical treatment since March 2009 to March 2015 in our hospital were included in current research. Surgical approaches were selected based on preoperative evaluations, including tumor locations, sizes, and growth patterns. Active measurements to manage water-electrolyte disorder and insipidus were taken for postoperative treatments. During the follow-up, patients were monitored for residual or recurrent tumor by postoperative contrast MRI scans done 1 to 3 months after surgery.The used surgical approaches were as follows: frontopterional approach (76 cases), anterior interhemispheric approach (58 cases), transcallosal approach (10 cases), transsphenoidal approach (15 cases), unilateral subfrontal approach (15 cases), and combined approaches (9 cases). Around 124 cases (72.7%) received total tumor resection, 37 patients (20.2%) underwent subtotal resection, and 13 patients (7.1%) underwent partial removal. No significant difference was found on the postoperative complications among the different microsurgical approaches (all, P > .05). A total of 111 cases had an intact pituitary stalk preservation and 26 cases had partially preserved stalks during surgery. Visual improvement was achieved in 54 patients and visual deterioration occurred in 22 cases. Postoperative insipidus appeared in 114 cases and water-electrolyte disorder occurred in 99 cases. The postsurgical follow-up ranged from 3 to 69 months with a mean duration of 27.3 months and 23 patients suffered recurrence.Based on careful preoperative evaluation, microsurgical treatments may be safe and effective approach to improve postoperative outcomes of craniopharyngioma patients.
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Coury JR, Davis BN, Koumas CP, Manzano GS, Dehdashti AR. Histopathological and molecular predictors of growth patterns and recurrence in craniopharyngiomas: a systematic review. Neurosurg Rev 2018; 43:41-48. [DOI: 10.1007/s10143-018-0978-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 01/01/2023]
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Rachinger W, Oehlschlaegel F, Kunz M, Fuetsch M, Schichor C, Thurau S, Schopohl J, Seelos K, Tonn JC, Kreth FW. Cystic Craniopharyngiomas: Microsurgical or Stereotactic Treatment? Neurosurgery 2018; 80:733-743. [PMID: 27973392 DOI: 10.1227/neu.0000000000001408] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prognosis and treatment of cystic craniopharyngiomas are poorly defined. OBJECTIVE To analyze progression-free survival (PFS) and safety profile of cystic craniopharyngiomas undergoing resection or minimally invasive drainage procedures. We compared further outcome measurements for cystic and solid tumors undergoing resection to elucidate the impact of the initial tumor composition on both PFS and the toxicity profile. METHODS All patients with craniopharyngiomas consecutively treated between 1999 and 2014 were included. A treatment decision in favor of microsurgery or stereotactic treatment was made interdisciplinarily. For stereotactic drainage, a catheter was implanted, allowing both permanent upstream (into ventricular spaces) and downstream (into prepontine cistern) drainage. Study endpoints were tumor progression, functional outcome, and treatment toxicity. Functional endocrinological and visual outcome analyses referred to data obtained preoperatively and 6 weeks after treatment. The Kaplan-Meier method was used for survival analysis. Prognostic factors were obtained from proportional hazard models. RESULTS Seventy-nine patients were included. The distribution of clinical and tumor-related data was well balanced among patients with solid (n = 35) and cystic (n = 44) tumors and those undergoing microsurgical or stereotactic treatment. Cystic tumors had shorter PFS (5-year PFS: 53.6% vs 66.8%, P = .10) and needed significantly more therapeutic interventions, which was independent of the initial treatment mode. The endocrinological deterioration rate was high for both solid and cystic tumors after microsurgery (59.4% and 85.7%, respectively), whereas it was significantly lower for cystic tumors undergoing stereotactic treatment (23.1%, P < .001). CONCLUSION Stereotactic bidirectional drainage of cystic craniopharyngiomas is effective and provides a better endocrinological outcome than conventional microsurgery.
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Affiliation(s)
- Walter Rachinger
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Florian Oehlschlaegel
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Manuel Fuetsch
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Stephan Thurau
- Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany
| | - Jochen Schopohl
- Medi-zinische Klinik und Poliklinik IV, Ludwig-Maximilians University, Mu-nich, Germany
| | - Klaus Seelos
- Department of Neuroradiology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
| | - Friedrich-Wilhelm Kreth
- Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-Univer-sity, Munich, Germany
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Graffeo CS, Perry A, Link MJ, Daniels DJ. Pediatric Craniopharyngiomas: A Primer for the Skull Base Surgeon. J Neurol Surg B Skull Base 2018; 79:65-80. [PMID: 29404243 PMCID: PMC5796826 DOI: 10.1055/s-0037-1621738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pediatric craniopharyngioma is a rare sellar-region epithelial tumor that, in spite of its typically benign pathology, has the potential to be clinically devastating, and presents a host of formidable management challenges for the skull base surgeon. Strategies in craniopharyngioma care have been the cause of considerable controversy, with respect to both philosophical and technical issues. Key questions remain unresolved, and include optimizing extent-of-resection goals; the ideal radiation modality and its role as an alternative, adjuvant, or salvage treatment; appropriate indications for expanded endoscopic endonasal surgery as an alternative to transcranial microsurgery; risks and benefits of skull base techniques in a pediatric population; benefits of and indications for intracavitary therapies; and the preferred management of common treatment complications. Correspondingly, we sought to review the preceding basic science and clinical outcomes literature on pediatric craniopharyngioma, so as to synthesize overarching recommendations, highlight major points of evidence and their conflicts, and assemble a general algorithm for skull base surgeons to use in tailoring treatment plans to the individual patient, tumor, and clinical course. In general terms, we concluded that safe, maximal, hypothalamic-sparing resection provides very good tumor control while minimizing severe deficits. Endoscopic endonasal, intraventricular, and transcranial skull base technique all have clear roles in the armamentarium, alongside standard craniotomies; these roles frequently overlap, and may be further optimized by using the approaches in adaptive combinations. Where aggressive subtotal resection is achieved, patients should be closely followed, with radiation initiated at the time of progression or recurrence-ideally via proton beam therapy, although three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and stereotactic radiosurgery are very appropriate in a range of circumstances, governed by access, patient age, disease architecture, and character of the recurrence. Perhaps most importantly, outcomes appear to be optimized by consolidated, multidisciplinary care. As such, we recommend treatment in highly experienced centers wherever possible, and emphasize the importance of longitudinal follow-up-particularly given the high incidence of recurrences and complications in a benign disease that effects a young patient population at risk of severe morbidity from hypothalamic or pituitary injury in childhood.
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Affiliation(s)
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - David J. Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Preti A, Karligkiotis A, Facco C, Ottini G, Volpi L, Castelnuovo P. Primary Ectopic Ethmoidal Craniopharyngioma. J Craniofac Surg 2018; 28:944-946. [PMID: 28403130 DOI: 10.1097/scs.0000000000003426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Craniopharyngiomas are benign but aggressive epithelial tumors usually originating in the anterior lobe of the pituitary gland from squamous remnants of an incompletely involuted craniopharingeal duct developing from the Rathke pouch. To the authors' knowledge only 1 patient of a primary isolated ethmoidal craniopharyngioma has been reported in the literature.The authors report the case of a 17-year-old boy with a primary extracranial ethmoidal craniopharyngioma. An endoscopic endonasal approach was employed to resect the tumor. After 2 years of clinical and radiological follow-up no recurrence of disease was observed.Primary ethmoidal craniopharyngiomas are rare entities and biopsy is necessary for diagnosis. However, a preoperative assessment by means of nasal endoscopy, computed tomography scan, and enhanced magnetic resonance imaging is mandatory to better evaluate the extension and characteristics of the tumor. The endoscopic endonasal technique is a safe and effective approach for the treatment of these lesions.
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Affiliation(s)
- Andrea Preti
- *Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences †Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese ‡Division of Otorhinolaryngology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari §Division of Pathology, Department of Surgical and Morphological Sciences, University of Insubria-Varese, Varese, Italy
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Wang F, Jiang J, Zhang J, Wang Q. Predicting pituitary stalk position by in vivo visualization of the hypothalamo-hypophyseal tract in craniopharyngioma using diffusion tensor imaging tractography. Neurosurg Rev 2017; 41:841-849. [DOI: 10.1007/s10143-017-0933-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/06/2017] [Accepted: 11/21/2017] [Indexed: 12/30/2022]
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Affiliation(s)
- Pietro Mortini
- San Raffaele University Hospital, Via Olgettina, Milan, 20132, Italy.
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Mortini P, Gagliardi F, Bailo M, Boari N, Castellano A, Falini A, Losa M. Resection of tumors of the third ventricle involving the hypothalamus: effects on body mass index using a dedicated surgical approach. Endocrine 2017; 57:138-147. [PMID: 27688008 DOI: 10.1007/s12020-016-1102-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022]
Abstract
Resection of large lesions growing into the third ventricle is considered nowadays still a demanding surgery, due to the high risk of severe endocrine and neurological complications. Some neurosurgical approaches were considered in the past the procedures of choice to access the third ventricle, however they were burden by endocrine and neurological consequences, like memory loss and epilepsy. We report here the endocrine and functional results in a series of patients operated with a recently developed approach specifically tailored for the resection of large lesions growing into the third ventricle. Authors conducted a retrospective analysis on 10 patients, operated between 2011 and 2012, for the resection of large tumors growing into the third ventricle. Total resection was achieved in all patients. No perioperative deaths were recorded and all patients were alive after the follow-up. One year after surgery 8/10 patients had an excellent outcome with a Karnofsky Performance Status of 100 and a Glasgow Outcome score of 5, with 8 patients experiencing an improvement of the Body Mass Index. Modern neurosurgery allows a safe and effective treatment of large lesions growing into the third ventricle with a postoperative good functional status.
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Affiliation(s)
- Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Department and CERMAC, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Neuroradiology Department and CERMAC, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Müller HL, Merchant TE, Puget S, Martinez-Barbera JP. New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma. Nat Rev Endocrinol 2017; 13:299-312. [PMID: 28155902 DOI: 10.1038/nrendo.2016.217] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Childhood-onset craniopharyngiomas are rare embryonic tumours of low-grade histological malignancy. Novel insights into the molecular pathogenesis of human adamantinomatous craniopharyngioma have started to unveil the possibility of testing novel treatments targeting pathogenic pathways. Hypothalamic involvement and/or treatment-related lesions result in impaired physical and social functionality and in severe neuroendocrine sequelae. Quality of survival in patients with craniopharyngioma with hypothalamic involvement is impaired by severe obesity, physical fatigue and non-optimal psychosocial development. Patients with craniopharyngioma involving hypothalamic structures have reduced 20-year overall survival, but overall and progression-free survival are not related to the degree of surgical resection. Irradiation is effective in the prevention of tumour progression and recurrence. For favourably localized craniopharyngiomas, the preferred treatment of choice is to attempt complete resection with preservation of visual, hypothalamic and pituitary function. For unfavourably localized tumours in close proximity to optic and/or hypothalamic structures, a radical neurosurgical strategy attempting complete resection is not recommended owing to potential severe sequelae. As expertise has been shown to have an impact on post-treatment morbidity, medical societies should establish criteria for adequate professional expertise for the treatment of craniopharyngioma. On the basis of these criteria, health authorities should organize the certification of centres of excellence that are authorized to treat and care for patients with this chronic disease.
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Affiliation(s)
- Hermann L Müller
- Department of Pediatrics and Pediatric Hematology and Oncology, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, Germany
| | - Thomas E Merchant
- Division of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105-3678, USA
| | - Stephanie Puget
- Service de Neurochirurgie, Hôpital Necker-Enfants Malades, Sorbonne Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Juan-Pedro Martinez-Barbera
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, University College London (UCL) Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Surgical Outcomes of Endoscopic Endonasal Skull Base Surgery of Craniopharyngiomas Evaluated According to the Degree of Hypothalamic Extension. World Neurosurg 2017; 100:288-296. [DOI: 10.1016/j.wneu.2017.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
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Abstract
PURPOSE This report is a review of findings on the diagnosis, treatment, clinical course, follow-up, and prognosis of craniopharyngioma patients with special regard to clinical trials and long-term management. METHODS Literature search on Pubmed for paper published after 1994. RESULTS Craniopharyngiomas are rare, embryonic malformations of the sellar/parasellar region with low histological grade. Clinical manifestations are related to increased intracranial pressure, visual impairment, and hypothalamic/pituitary deficiencies. If the tumor is favorably localized, therapy of choice is complete resection, with care taken to preserve hypothalamic and optic functions. In patients with unfavorable tumor location (i.e. involvement of hypothalamic areas), recommended therapy is limited hypothalamus-sparing surgical strategy followed by irradiation. Irradiation has proven effective in treatment of recurrences and progression. Surgical lesions and/or anatomical involvement of posterior hypothalamic areas can result in serious sequelae, mainly hypothalamic syndrome. CONCLUSIONS It is crucial that craniopharyngioma be managed as a frequently chronic disease, providing ongoing care of pediatric and adult patients' by experienced multidisciplinary teams in the context of multicenter trials.
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Affiliation(s)
- Hermann L Müller
- Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133, Oldenburg, Germany.
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Tan TSE, Patel L, Gopal-Kothandapani JS, Ehtisham S, Ikazoboh EC, Hayward R, Aquilina K, Skae M, Thorp N, Pizer B, Didi M, Mallucci C, Blair JC, Gaze MN, Kamaly-Asl I, Spoudeas H, Clayton PE. The neuroendocrine sequelae of paediatric craniopharyngioma: a 40-year meta-data analysis of 185 cases from three UK centres. Eur J Endocrinol 2017; 176:359-369. [PMID: 28073908 DOI: 10.1530/eje-16-0812] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The management of paediatric craniopharyngiomas was traditionally complete resection (CR), with better reported tumour control compared to that by partial resection (PR) or limited surgery (LS). The subsequent shift towards hypothalamic sparing, conservative surgery with adjuvant radiotherapy (RT) to any residual tumour aimed at reducing neuroendocrine morbidity, has not been systematically studied. Hence, we reviewed the sequelae of differing management strategies in paediatric craniopharyngioma across three UK tertiary centres over four decades. METHODS Meta-data was retrospectively reviewed over two periods before (1973-2000 (Group A: n = 100)) and after (1998-2011 (Group B: n = 85)) the introduction of the conservative strategy at each centre. RESULTS Patients had CR (A: 34% and B: 19%), PR (A: 48% and B: 46%) or LS (A: 16% and B: 34%), with trends reflecting the change in surgical approach over time. Overall recurrence rates between the two periods did not change (A: 38% vs B: 32%). More patients received RT in B than A, but recurrence rates were similar: for A, 28% patients received RT with 9 recurrences (32%); for B, 62% received RT with 14 recurrences (26%). However, rates of diabetes insipidus (P = 0.04), gonadotrophin deficiency (P < 0.001) and panhypopituitarism (P = 0.001) were lower in B than those in A. In contrast, post-operative obesity (BMI SDS >+2.0) (P = 0.4) and hypothalamic (P = 0.1) and visual (P = 0.3) morbidity rates were unchanged. CONCLUSION The shift towards more conservative surgery has reduced the prevalence of hormone deficiencies, including diabetes insipidus, which can be life threatening. However, it has not been associated with reduced hypothalamic and visual morbidities, which remain a significant challenge. More effective targeted therapies are necessary to improve outcomes.
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Affiliation(s)
- Timothy Shao Ern Tan
- Royal Manchester Children's HospitalManchester, UK
- The School of Medical SciencesFaculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Leena Patel
- Royal Manchester Children's HospitalManchester, UK
- The School of Medical SciencesFaculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | | | | | - Richard Hayward
- Great Ormond Street Hospital for Children NHS Foundation TrustLondon, UK
| | - Kristian Aquilina
- Great Ormond Street Hospital for Children NHS Foundation TrustLondon, UK
| | - Mars Skae
- Royal Manchester Children's HospitalManchester, UK
| | - Nicky Thorp
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
| | - Mohammed Didi
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
| | | | | | - Mark N Gaze
- Great Ormond Street Hospital for Children NHS Foundation TrustLondon, UK
- University College London Hospitals NHS Foundation TrustLondon, UK
| | | | - Helen Spoudeas
- Great Ormond Street Hospital for Children NHS Foundation TrustLondon, UK
- University College London Hospitals NHS Foundation TrustLondon, UK
| | - Peter E Clayton
- Royal Manchester Children's HospitalManchester, UK
- The School of Medical SciencesFaculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Stache C, Bils C, Fahlbusch R, Flitsch J, Buchfelder M, Stefanits H, Czech T, Gaipl U, Frey B, Buslei R, Hölsken A. Drug priming enhances radiosensitivity of adamantinomatous craniopharyngioma via downregulation of survivin. Neurosurg Focus 2017; 41:E14. [PMID: 27903123 DOI: 10.3171/2016.9.focus16316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors investigated the underlying mechanisms responsible for high tumor recurrence rates of adamantinomatous craniopharyngioma (ACP) after radiotherapy and developed new targeted treatment protocols to minimize recurrence. ACPs are characterized by the activation of the receptor tyrosine kinase epidermal growth factor receptor (EGFR), known to mediate radioresistance in various tumor entities. The impact of tyrosine kinase inhibitors (TKIs) gefitinib or CUDC-101 on radiation-induced cell death and associated regulation of survivin gene expression was evaluated. METHODS The hypothesis that activated EGFR promotes radioresistance in ACP was investigated in vitro using human primary cell cultures of ACP (n = 10). The effects of radiation (12 Gy) and combined radiochemotherapy on radiosensitivity were assessed via cell death analysis using flow cytometry. Changes in target gene expression were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Survivin, identified in qRT-PCR to be involved in radioresistance of ACP, was manipulated by small interfering RNA (siRNA), followed by proliferation and vitality assays to further clarify its role in ACP biology. Immunohistochemically, survivin expression was assessed in patient tumors used for primary cell cultures. RESULTS In primary human ACP cultures, activation of EGFR resulted in significantly reduced cell death levels after radiotherapy. Treatment with TKIs alone and in combination with radiotherapy increased cell death response remarkably, assessed by flow cytometry. CUDC-101 was significantly more effective than gefitinib. The authors identified regulation of survivin expression after therapeutic intervention as the underlying molecular mechanism of radioresistance in ACP. EGFR activation promoting ACP cell survival and proliferation in vitro is consistent with enhanced survivin gene expression shown by qRT-PCR. TKI treatment, as well as the combination with radiotherapy, reduced survivin levels in vitro. Accordingly, ACP showed reduced cell viability and proliferation after survivin downregulation by siRNA. CONCLUSIONS These results indicate an impact of EGFR signaling on radioresistance in ACP. Inhibition of EGFR activity by means of TKI treatment acts as a radiosensitizer on ACP tumor cells, leading to increased cell death. Additionally, the results emphasize the antiapoptotic and pro-proliferative role of survivin in ACP biology and its regulation by EGFR signaling. The suppression of survivin by treatment with TKI and combined radiotherapy represents a new promising treatment strategy that will be further assessed in in vivo models of ACP.
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Affiliation(s)
- Christina Stache
- Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute of Child Health, University College London, United Kingdom
| | - Christiane Bils
- Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Jörg Flitsch
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Harald Stefanits
- Department of Neurosurgery, Medical University of Vienna, Austria; and
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Austria; and
| | - Udo Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rolf Buslei
- Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Annett Hölsken
- Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Olivari-Philiponnet C, Roumenoff F, Schneider M, Chantran C, Picot M, Berlier P, Mottolese C, Bernard JC, Vuillerot C. Morbidité et impact sur la participation sociale du craniopharyngiome de l’enfant. Arch Pediatr 2016; 23:1225-1232. [DOI: 10.1016/j.arcped.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
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Li Q, You C, Zhou L, Sima X, Liu Z, Liu H, Xu J. High FABP5 Versus CRABPII Expression Ratio in Recurrent Craniopharyngiomas: Implications for Future Treatment. World Neurosurg 2016; 94:197-205. [PMID: 27418530 DOI: 10.1016/j.wneu.2016.05.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Recurrence is a major problem in craniopharyngioma (CP) management. Recent study shows that high FABP5/CRABPII may be related to tumor growth and that all-trans retinoic acid (ATRA) may suppress primary CP growth. We studied the expression profile of FABP5 and CRABPII in recurrent CP tissue and the effect of ATRA on recurrent CP cells. METHODS Fifty cases of patients with CP were enrolled in the retrospective study. Among them, 15 were recurrent. Fresh specimens were collected for immunohistochemistry, reverse transcription polymerase chain reaction, and western blotting analysis of FABP5 and CRABPII. Fresh specimens from 6 primary and recurrent CPs were collected and subjected to cell culture using an explants method. ATRA at various concentrations was applied to recurrent CP cell culture, and cell growth was recorded and analyzed. RESULTS Immunohistochemistry, reverse transcription polymerase chain reaction, and western blot study showed that FABP5 was expressed significantly higher in recurrent tumors, whereas CRABPII was expressed significantly higher in primary tumors. The FABP5/CRABPII ratio was significantly higher in recurrent rather than primary tumors. Recurrent CP cells grew faster than primary cells, and ATRA induced cellular apoptosis and inhibited CP cell growth in a dose-dependent manner. CONCLUSIONS A high expression ratio between FABP5 and CRABPII may be related to CP tumor recurrence and ATRA could be a potential therapeutic agent for CP chemotherapy.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xiutian Sima
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Hao Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
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Müller HL. Risk-adapted treatment and follow-up management in childhood-onset craniopharyngioma. Expert Rev Neurother 2016; 16:535-48. [DOI: 10.1586/14737175.2016.1166959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
PURPOSE OF REVIEW Hypothalamic alterations, pathological or treatment induced, have major impact on prognosis in craniopharyngioma patients mainly because of consequent hypothalamic obesity. Recent insight in molecular genetics, treatment strategies, risk factors and outcomes associated with hypothalamic obesity provide novel therapeutic perspectives. This review includes relevant publications since 2013. RECENT FINDINGS Recent findings confirm that alterations in posterior hypothalamic areas because of tumour location and/or treatment-related injuries are associated with severe hypothalamic obesity, reduced overall survival and impaired quality of life in long-term survivors of childhood-onset craniopharyngioma. However, eating disorders are observed because of hypothalamic obesity without clear disease-specific patterns. Treatment options for hypothalamic obesity are very limited. Treatment with invasive, nonreversible bariatric methods such as Roux-en-Y gastric bypass is most efficient in weight reduction, but controversial in the paediatric population because of medical, ethical, and legal considerations. Accordingly, treatment in craniopharyngioma should focus on prevention of (further) hypothalamic injury. Presurgical imaging for grading of hypothalamic involvement should be the basis for hypothalamus-sparing strategies conducted by experienced multidisciplinary teams. SUMMARY Until a nonsurgical therapeutic option for hypothalamic obesity for paediatric patients is found, prevention of hypothalamic injury should be the preferred treatment strategy, conducted exclusively by experienced multidisciplinary teams.
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Affiliation(s)
- Hermann L Müller
- Department of Pediatrics, Klinikum Oldenburg, Medical Campus University Oldenburg, Oldenburg, Germany
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Mortini P, Gagliardi F, Bailo M, Spina A, Parlangeli A, Falini A, Losa M. Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas. Endocrine 2016; 51:148-62. [PMID: 26179178 DOI: 10.1007/s12020-015-0683-x] [Citation(s) in RCA: 26] [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: 03/01/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Quality of life of craniopharyngioma patients can be severely impaired by derangement of hypothalamic function. A classification, taking into account preoperative hypothalamic damage, evaluated by magnetic resonance imaging (MRI), and correlating it with postoperative weight change is still missing in the literature. The aim of our study is to identify objective radiological criteria as preoperative prognostic factors for hypothalamic damage. Pre- and post-operative MRI and clinical data of 47 patients, treated at our Institution for craniopharyngioma, were retrospectively analyzed, based on radiological variables, identified as prognostic factor for hypothalamic involvement. Main factors associated with postoperative obesity were hypothalamic hyperintensity in T2-weighted/FLAIR imaging (p < 0.033), mammillary body involvement according to Müller classification (p < 0.020), unidentifiable pituitary stalk (p < 0.001), dislocated chiasm (p < 0.038), either not visible infundibular recess (p < 0.019) or unrecognizable supra-optic recess (p < 0.004), and retrochiasmatic tumor extension (p < 0.019). Accordingly, postoperative hypothalamic syndrome was associated with peritumoral edema in T2-weighted/FLAIR images (p < 0.003), unidentifiable hypothalamus (p < 0.024), hypothalamic compression (p < 0.006), fornix displacement (p < 0.032), and unrecognizable supra-optic recess (p < 0.031). Ultimately, variables identified as predictive factors of postoperative hypothalamic syndrome were the degree of hypothalamic involvement according to the classification described by Sainte-Rose and Puget (p < 0.002; grade 0 vs 2 p < 0.001), Van Gompel (p < 0.002; grade 0 vs 1, p < 0.027; and grade 0 vs 2, p < 0.002), and Muller (p < 0.006; grade 0 vs 1, p < 0.05; and grade 0 vs 2, p < 0.004). The identification of these predictive factors will help to define and score the preoperative hypothalamic involvement in craniopharyngioma patients.
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Affiliation(s)
- Pietro Mortini
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Michele Bailo
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrea Parlangeli
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Li Z, Xu J, Huang S, You C. Aberrant membranous expression of β-catenin predicts poor prognosis in patients with craniopharyngioma. Ann Diagn Pathol 2015; 19:403-8. [DOI: 10.1016/j.anndiagpath.2015.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/23/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022]
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Lee EJ, Cho YH, Hong SH, Kim JH, Kim CJ. Is the Complete Resection of Craniopharyngiomas in Adults Feasible Considering Both the Oncologic and Functional Outcomes? J Korean Neurosurg Soc 2015; 58:432-41. [PMID: 26713143 PMCID: PMC4688312 DOI: 10.3340/jkns.2015.58.5.432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/19/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the impact of the complete resection of craniopharyngioma (CP) in adults on oncologic and functional outcomes. METHODS We retrospectively analyzed 82 patients with CP who were surgically treated by the same neurosurgeon at our institution between January 1994 and December 2012. RESULTS Gross total resection (GTR) was achieved in 71 patients (86.6%), near total resection (NTR) in 7 patients (8.5%), and subtotal resection (STR) in 3 patients (3.7%). The disease-specific overall survival rate was 100% with the exclusion of 2 surgery-related mortalities. The overall recurrence rate was 12.2% (10 of 82 patients), however the recurrence rate according to extent of resection (EOR) was 9.9% (7 of 71 patients) after GTR, 14.3% (1 of 7 patients) after NTR, and 66.7% (2 of 3 patients) after STR. The overall recurrence-free survival (RFS) rates at 5 and 10 years were 87.0% and 76.8%, respectively. Postoperatively, most patients (86.3%) needed hormone replacement for at least 1 hypothalamic-pituitary axis. Vision improved in 56.4% of the patients with preoperative abnormal vision, but deteriorated in 27.4% of patients. Hypothalamic dysfunction developed in 32.9% of patients. There were no significant differences in the risks of pituitary dysfunction, visual deterioration, or hypothalamic dysfunction between the groups with complete vs. incomplete removal. The overall rate of postoperative complications was 22.0%, which did not differ between groups (p=0.053). CONCLUSION The complete removal of a CP at first surgery can provide a chance for a cure with acceptable morbidity and mortality risks.
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Affiliation(s)
- Eun Jung Lee
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Khan MJ, Humayun KN, Donaldson M, Ahmed SF, Shaikh MG. Longitudinal changes in body mass index in children with craniopharyngioma. Horm Res Paediatr 2015; 82:372-9. [PMID: 25359623 DOI: 10.1159/000368798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/30/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We investigated the relationship of body mass index at presentation and pituitary status with long-term changes in BMI over a period of 5 years. STUDY DESIGN Craniopharyngioma patients (n = 25) attending a tertiary pediatric endocrine center were divided into three groups based on their BMI at presentation [BMI ≥ 2 standard deviation scores (SDS), 0-1.99 SDS, and <0 SDS) and then analyzed for trends of BMI over a period of up to 5 years. RESULTS Median (interquartile range) BMI SDS and hypopituitarism at presentation versus at the 5-year follow-up were as follows: BMI SDS ≥ 2 group (n = 10): 3.55 (0.68), 6/10 versus 3.76 (1.13), 8/10; BMI SDS 0-1.99 group (n = 11): 1.68 (1.05), 3/11 versus 1.64 (2.04), 7/11, and BMI SDS <0 group (n = 4): -0.23 (0.93), 2/4 versus 0.61, 4/4. At the 5-year follow-up, 10/10, 7/11, and 1/4 subjects when divided in groups according to BMI at presentation were obese. CONCLUSIONS Our data indicate that obesity at presentation, rather than panhypopituitarism either at or after presentation, predicts obesity 5 years after diagnosis. However, obesity at presentation is not always associated with the subsequent development of panhypopituitarism. Pediatric craniopharyngioma subjects who have BMI SDS ≥ 2 at presentation require early and aggressive intervention to help prevent the complications of obesity.
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Affiliation(s)
- Muhammad Jaffar Khan
- Section of Human Nutrition (University of Glasgow), Glasgow Royal Infirmary, Glasgow, UK
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Varlotto J, DiMaio C, Grassberger C, Tangel M, Mackley H, Pavelic M, Specht C, Sogge S, Nguyen D, Glantz M, Saw C, Upadhyay U, Moser R, Yunus S, Rava P, Fitzgerald T, Glanzman J, Sheehan J. Multi-modality management of craniopharyngioma: a review of various treatments and their outcomes. Neurooncol Pract 2015; 3:173-187. [PMID: 31386091 DOI: 10.1093/nop/npv029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Indexed: 02/04/2023] Open
Abstract
Craniopharyngioma is a rare tumor that is expected to occur in ∼400 patients/year in the United States. While surgical resection is considered to be the primary treatment when a patient presents with a craniopharyngioma, only 30% of such tumors present in locations that permit complete resection. Radiotherapy has been used as both primary and adjuvant therapy in the treatment of craniopharyngiomas for over 50 years. Modern radiotherapeutic techniques, via the use of CT-based treatment planning and MRI fusion, have permitted tighter treatment volumes that allow for better tumor control while limiting complications. Modern radiotherapeutic series have shown high control rates with lower doses than traditionally used in the two-dimensional treatment era. Intracavitary radiotherapy with radio-isotopes and stereotactic radiosurgery may have a role in the treatment of recurrent cystic and solid recurrences, respectively. Recently, due to the exclusive expression of the Beta-catenin clonal mutations and the exclusive expression of BRAF V600E clonal mutations in the overwhelming majority of adamantinomatous and papillary tumors respectively, it is felt that inhibitors of each pathway may play a role in the future treatment of these rare tumors.
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Affiliation(s)
- John Varlotto
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Christopher DiMaio
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Clemens Grassberger
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Matthew Tangel
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Heath Mackley
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Matt Pavelic
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Charles Specht
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Steven Sogge
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Dan Nguyen
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Michael Glantz
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Cheng Saw
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Urvashi Upadhyay
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Richard Moser
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Shakeeb Yunus
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Paul Rava
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Thomas Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Jonathan Glanzman
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
| | - Jonas Sheehan
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (J.V., P.R., T.F., J.G.); Penn State Hershey Medical Center, Department of Neurology, Hershey, Pennsylvania (C.D.); Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts (C.G.); Pennsylvania State University College of Medicine, Hershey, Pennsylvania (M.T., M.P., C.S., D.N., M.G., J.S.); Penn State Hershey Cancer Institute, Hershey, Pennsylvania (H.M.); Penn State Medical Center, Department of Pathology, Hershey, Pennsylvania (C.S., D.N.); Penn State Hershey Medical Center, Department of Radiology, Hershey, Pennsylvania (D.N.); Penn State Neuroscience Institute, Hershey, Pennsylvania (D.N., M.G., J.S.); Northeast Radiation Oncology, Scranton, Pennsylvania (C.S.); University of Massachusetts Medical Center, Division of Neurologic Surgery, Worcester, Massachusetts (U.U., R.M.); Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (S.Y.)
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Conroy R, Gomes L, Owen C, Buchsbaum J, Ahern V. Clinical equipoise: Protons and the child with craniopharyngioma. J Med Imaging Radiat Oncol 2014; 59:379-85. [DOI: 10.1111/1754-9485.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth Conroy
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
| | - Lavier Gomes
- Medical Imaging; Westmead Hospital; Sydney New South Wales Australia
| | - Catherine Owen
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
| | - Jeffrey Buchsbaum
- Departments of Radiation Oncology, Paediatrics, and Neurological Surgery; Indiana University College of Arts and Sciences; Indiana University School of Medicine; Bloomington Indiana USA
- Department of Physics; IU Proton Therapy Center; Riley Hospital for Children; Indiana University Hospital; Bloomington Indiana USA
| | - Verity Ahern
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
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Matsuo T, Kamada K, Izumo T, Nagata I. Indication and limitations of endoscopic extended transsphenoidal surgery for craniopharyngioma. Neurol Med Chir (Tokyo) 2014. [PMID: 25446384 PMCID: PMC4533352 DOI: 10.2176/nmc.oa.2014-0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The transsphenoidal approach has been utilized in intrasellar craniopharyngioma surgeries. However, the advent of endoscopic extended transsphenoidal approach (EETSA) has expanded its indication to suprasellar craniopharyngiomas. We compared the indication and limitations of EETSA to those of uni-lateral basal interhemispheric approach (UBIHA), which presents similar indications for surgery. We analyzed 30 patients with tumors located below the foramen of Monro and the lateral boundary extending slightly beyond the internal carotid artery (UBIHA: N = 18; EETSA: N = 12). Postoperative magnetic resonance imaging (MRI) revealed gross total resection in 10 patients in the EETSA group (83.3%) and 12 in the UBIHA group (66.7%). Postoperative MRI in the EETSA group revealed residual tumor at the cavernous sinus in one patient, at the prepontine in one; in the UBIHA group, residual tumors were located in the retrochiasmatic area in two patients, infundibulum-hypothalamus in one, on the stalk in one, and in the intrasellar region in two. No intergroup differences were observed in the preservation of pituitary function and postoperative improvement of visual function. The extent of resection was better with EETSA than with UBIHA. EETSA is considered the first-line therapy because the distance between the optic chiasm and the superior border of the pituitary is large; the lateral extension does not go beyond the internal carotid artery; and the tumor does not extend inferiorly beyond the posterior clinoid process. However, in patients showing poorly developed sphenoid sinuses or pituitary stalks anterior to the tumor, surgery is difficult regardless of the selection criteria.
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Affiliation(s)
- Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University School of Medicine
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Zaidi HA, Chapple K, Little AS. National treatment trends, complications, and predictors of in-hospital charges for the surgical management of craniopharyngiomas in adults from 2007 to 2011. Neurosurg Focus 2014; 37:E6. [DOI: 10.3171/2014.8.focus14366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Treatment of craniopharyngiomas is one of the most demanding and controversial neurosurgical procedures performed. The authors sought to determine the factors associated with hospital charges and fees for craniopharyngioma treatment to identify possible opportunities for improving the health care economics of inpatient care.
Methods
The authors analyzed the hospital discharge database of the Nationwide Inpatient Sample (NIS) covering the period from 2007 through 2011 to examine national treatment trends for adults (that is, those older than 18 years) who had undergone surgery for craniopharyngioma. To predict the drivers of in-hospital charges, a multistep regression model was developed that accounted for patient demographics, acuity measures, comorbidities, hospital characteristics, and complications.
Results
The analysis included 606 patients who underwent resection of craniopharyngioma; 353 resections involved a transsphenoidal approach (58%) and 253 a transfrontal approach (42%). The mean age (± SD) of patients was 47.7 ± 16.3 years. The average hospital length of stay (LOS) was 7.6 ± 9 days. The mean hospital charge (± SD) was $92,300 ± $83,356. In total, 48% of the patients experienced postoperative diabetes insipidus or an electrolyte abnormality. A multivariate regression model demonstrated that LOS, hospital volume for the selected procedure, the surgical approach, postoperative complications, comorbidities, and year of surgery were all significant predictors of in-hospital charges. The statistical model accounted for 54% of the variance in in-hospital charge.
Conclusions
This analysis of inpatient hospital charges in patients undergoing craniopharyngioma surgery identified key drivers of charges in the perioperative period. Prospective studies designed to evaluate the long-term resource utilization in this complex patient population would be a useful future direction.
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Thorp N, Taylor R. Management of Central Nervous System Tumours in Children. Clin Oncol (R Coll Radiol) 2014; 26:438-45. [DOI: 10.1016/j.clon.2014.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
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