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Kayadjanian N, Hsu EA, Wood AM, Carson DS. Caregiver Burden and Its Relationship to Health-Related Quality of Life in Craniopharyngioma Survivors. J Clin Endocrinol Metab 2023; 109:e76-e87. [PMID: 37597173 PMCID: PMC10735386 DOI: 10.1210/clinem/dgad488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 08/21/2023]
Abstract
CONTEXT Craniopharyngioma (CP) is a rare brain tumor associated with severe comorbidities that reduce survivor health-related quality of life (HRQOL). However, CP impact on caregivers is unknown. OBJECTIVE To measure caregiver burden and examine its relationship to survivor HRQOL and other determinants in CP. METHODS Eighty-two participants who self-identified as caregivers of CP survivors responded to an online survey including caregiver-reported Pediatric Quality of Life Inventory (PedsQL), and the Zarit Burden Interview (ZBI). RESULTS Caregivers reported an average of 13 out of 29 health conditions in survivors following tumor treatment, including excess weight, hypopituitarism, fatigue, mood, cognition, social issues, temperature dysregulation, visual impairment, and sleep problems. Strikingly, 70% of survivors who experienced obesity also experienced hyperphagia. ZBI scores were moderate with a median of 37. PedsQL total scores were poor with a median of 46.2. ZBI scores were independent of caregiver level of education and care duration. Both scores were independent of income, survivor age, gender, age at diagnosis, or tumor recurrence. In contrast, both scores depended on the number (P < .001) and the type of survivor health problems, with significantly worse scores for caregivers or survivors with symptoms of hypothalamic dysfunction (P < .001) including hyperphagia but not obesity. PedsQL total scores significantly predicted ZBI scores (P < .001). CONCLUSION Survivor poly-symptomatology predicted and incurred significant caregiver burden. Our study separated hyperphagia and obesity and identified hyperphagia and other hypothalamic dysfunction symptoms as understudied issues. Altogether, these findings draw particular attention to the unmet needs of CP survivors and their caregivers.
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Affiliation(s)
| | - Eugenie A Hsu
- Raymond A. Wood Foundation, Ocean City, MD 21842, USA
| | - Amy M Wood
- Raymond A. Wood Foundation, Ocean City, MD 21842, USA
| | - Dean S Carson
- Raymond A. Wood Foundation, Ocean City, MD 21842, USA
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Sherman SJ, Tanaka R, Qaddoumi I. Psychiatric symptoms in children with low-grade glioma and craniopharyngioma: A systematic review. J Psychiatr Res 2022; 148:240-249. [PMID: 35149436 DOI: 10.1016/j.jpsychires.2022.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
The presentation of psychiatric symptoms in pediatric low-grade brain tumors is challenging because this can delay proper diagnosis and treatment. We performed a systematic review of psychiatric presenting symptoms of low-grade brain tumors in pediatric patients. We searched the PubMed and Web of Science databases of studies published in English from 1977 until 2019 reporting patients aged ≤21 years at the time of tumor diagnosis who exhibited psychiatric/behavioral symptoms before diagnosis of low-grade glioma (LGG), pilocytic astrocytoma (PA), or craniopharyngioma (CP). Our systematic search strategy coupled each tumor type with patient age and presenting symptoms by using different variations of the search terms "childhood" and "psychiatric symptoms" or "behavioral symptoms." We identified six unique articles that met our inclusion criteria in the LGG search, 27 in the PA search, and 32 in the CP search. Six patients were included in the LGG articles (age range, 3-16 years), 75 in the PA articles (age range, 0.5-21 years), and 87 in the CP articles (age range, 0.67-21 years). The most common presenting symptoms included eating disorders (n = 64) and behavioral changes (n = 49). Our findings demonstrate the need to establish clear criteria for neuroimaging indications for pediatric patients exhibiting eating disorders.
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Affiliation(s)
- Sarah J Sherman
- St. Jude Children's Research Hospital Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Young K, Bowers A, Bradford N. Families' experiences of child and adolescent brain tumor: A systematic review and synthesis of qualitative research. Psychooncology 2021; 30:1643-1662. [PMID: 34124814 DOI: 10.1002/pon.5745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Brain tumors are the most common and fatal of all solid tumors for children and adolescents; those who survive live with long-term physical and emotional consequences, as do their families. We aimed to synthesize relevant qualitative evidence on families' experiences and psychosocial service needs across the lifespan to identify gaps in care delivery and research. METHODS Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science. Identified papers were assessed with the Joanna Briggs Institute Critical Appraisal Tool. Data were extracted into NVivo12 and analyzed by qualitative description and, where appropriate, thematic analysis. RESULTS The search yielded 628 papers, of which 40 (33 studies) were eligible (6%). Although the methodological quality of the papers was low, we identified concerns that were consistently reported over time and from different perspectives. Individual family members had varying psychosocial needs to be addressed within healthcare, schooling, and public policy. These include for survivor's mental health (particularly for body image), and to the disproportionate biopsychosocial burden faced by mother-caregivers. CONCLUSIONS Addressing the biological aspects of brain tumor cannot be our only focus. We have an obligation to provide services that meet the needs of families across diagnosis, treatment, survivorship, palliative care, and bereavement.
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Affiliation(s)
- Kate Young
- Cancer and Palliative Care Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alison Bowers
- Cancer and Palliative Care Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.,Center for Children's Health Research, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.,Center for Children's Health Research, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
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A Qualitative Study Exploring Coping Strategies in Chinese Families During Children's Hospitalization for Cancer Treatment. J Pediatr Nurs 2019; 48:e27-e34. [PMID: 31253520 DOI: 10.1016/j.pedn.2019.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore how Chinese families cope with children's hospitalization for cancer treatment. DESIGN AND METHODS A descriptive qualitative inquiry was employed. Semi-structured interview was conducted in four pediatric oncology departments in four hospitals from November 2017 to June 2018. The interviews focused on how families cope with the challenges resulting from their children's hospitalization for cancer treatment. Twenty one parents participated into the study. RESULTS Four categories related to family coping strategies emerged from the data, including increasing family strength, maintaining optimistic thoughts, seeking external support, and not disclosing the unfavorable information. CONCLUSIONS Families had adopted multiple coping strategies to handle the challenges caused by children's hospitalization for cancer treatment. The influences of Chinese culture on family coping should be taken into consideration during family-centered interventions development. Further studies could analyze whether the spouse perspectives are independent from one another and whether the coping strategies change as the time of hospitalization. PRACTICE IMPLICATIONS This study has reminded nurses' to become more concerned about the influences of culture on families' coping strategies during this challenging period. Other nurses in the world could understand how to enhance family coping strategies of Chinese clients.
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Jackson AC, Stewart H, O'Toole M, Tokatlian N, Enderby K, Miller J, Ashley D. Pediatric Brain Tumor Patients: Their Parents’ Perceptions of the Hospital Experience. J Pediatr Oncol Nurs 2016; 24:95-105. [PMID: 17332423 DOI: 10.1177/1043454206296030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Studies have shown that admission to the hospital of a child can induce feelings of fear and helplessness in parents, challenging usual patterns of coping and parenting competence. Stress has been associated with parents’ need to establish effective communication with staff and their need for information, ready access to their children, and participation in decision making relating to their child’s care. This study of coping and adjustment was undertaken with the parents, including mothers and fathers, of children under 18 years of age diagnosed with a brain tumor, presenting at Royal Children’s Hospital, Melbourne, between 2001 and 2002 (N = 53). It was a prospective study using repeated measures over time. Participants in the study were involved in a questionnaire interview at 4 different points: at the time of diagnosis, 6 months postdiagnosis, 1 year postdiagnosis, and 2 years postdiagnosis, in which they were asked, among other things, about their experience of the hospital. The point of diagnosis was marked by a high level of dependence, with parents coping with rapid decision making and shock, and the surrender of care of their child. Parents identified high levels of information need but noted that they were often too stressed to take in information early on, and that this information need persisted up to the 2-year postdiagnosis point. More parents expressed dissatisfaction with the hospital and particularly with their interactions with the health care team at the 6-month post-diagnosis period, reflecting a possible reduction in attention given to families once they had settled into the treatment routine and the crisis of diagnosis had passed.
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Affiliation(s)
- Alun C Jackson
- University of Melbourne School of Social Work, Victoria, Australia.
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Jackson AC, Frydenberg E, Liang RPT, Higgins RO, Murphy BM. Familial impact and coping with child heart disease: a systematic review. Pediatr Cardiol 2015; 36:695-712. [PMID: 25618163 DOI: 10.1007/s00246-015-1121-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
Families of children with congenital heart disease (CHD) cope differently depending on individual and familial factors beyond the severity of the child's condition. Recent research has shifted from an emphasis on the psychopathology of family functioning to a focus on the resilience of families in coping with the challenges presented by a young child's condition. The increasing number of studies on the relationship between psychological adaptation, parental coping and parenting practices and quality of life in families of children with CHD necessitates an in-depth re-exploration. The present study reviews published literature in this area over the past 25 years to generate evidence to inform clinical practice, particularly to better target parent and family interventions designed to enhance family coping. Twenty-five studies were selected for inclusion, using the PRISMA guidelines. Thematic analysis identified a number of themes including psychological distress and well-being, gender differences in parental coping, and variable parenting practices and a number of subthemes. There is general agreement in the literature that families who have fewer psychosocial resources and lower levels of support may be at risk of higher psychological distress and lower well-being over time, for both parent and the child. Moreover, familial factors such as cohesiveness and adaptive parental coping strategies are necessary for successful parental adaptation to CHD in their child. The experiences, needs and ways of coping in families of children with CHD are diverse and multi-faceted. A holistic approach to early psychosocial intervention should target improved adaptive coping and enhanced productive parenting practices in this population. This should lay a strong foundation for these families to successfully cope with future uncertainties and challenges at various phases in the trajectory of the child's condition.
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Affiliation(s)
- Alun C Jackson
- Heart Research Centre, 14-20 Blackwood Street, North Melbourne, VIC, 3051, Australia,
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Zada G, Kintz N, Pulido M, Amezcua L. Prevalence of neurobehavioral, social, and emotional dysfunction in patients treated for childhood craniopharyngioma: a systematic literature review. PLoS One 2013; 8:e76562. [PMID: 24223703 PMCID: PMC3818366 DOI: 10.1371/journal.pone.0076562] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/31/2013] [Indexed: 11/18/2022] Open
Abstract
Background Craniopharyngiomas (CP) are locally invasive and frequently recurring neoplasms often resulting in neurological and endocrinological dysfunction in children. In addition, social-behavioral impairment is commonly reported following treatment for childhood CP, yet remains to be fully understood. The authors aimed to further characterize the prevalence of neurobehavioral, social, and emotional dysfunction in survivors of childhood craniopharyngiomas. Materials and Methods A systematic literature review was conducted in PubMed to identify studies formally assessing neurobehavioral, social, and emotional outcomes in patients treated for CP prior to 18 years of age. Studies published between the years 1990-2012 that reported the primary outcome (prevalence of neurobehavioral, social, emotional/affective dysfunction, and/or impaired quality of life (QoL)) in ≥10 patients were included. Results Of the 471 studies screened, 11 met inclusion criteria. Overall neurobehavioral dysfunction was reported in 51 of 90 patients (57%) with available data. Social impairment (i.e. withdrawal, internalizing behavior) was reported in 91 of 222 cases (41%). School dysfunction was reported in 48 of 136 patients (35%). Emotional/affective dysfunction was reported in 58 of 146 patients (40%), primarily consisting of depressive symptoms. Health related quality of life was affected in 49 of 95 patients (52%). Common descriptors of behavior in affected children included irritability, impulsivity, aggressiveness, and emotional outbursts. Conclusions Neurobehavioral, social, and emotional impairment is highly prevalent in survivors of childhood craniopharyngioma, and often affects quality of life. Thorough neurobehavioral/emotional screening and appropriate counseling is recommended in this population. Additional research is warranted to identify risk factors and treatment strategies for these disorders.
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Affiliation(s)
- Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, United States of America
- * E-mail:
| | - Natalie Kintz
- The George and MaryLou Boone Center for Parkinson’s Disease Research, Keck School of Medicine of USC, Los Angeles, California, United States of America
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Mario Pulido
- Department of Biochemistry and Molecular Biology, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, California, United States of America
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Weismann D, Pelka T, Bender G, Jurowich C, Fassnacht M, Thalheimer A, Allolio B. Bariatric surgery for morbid obesity in craniopharyngioma. Clin Endocrinol (Oxf) 2013; 78:385-90. [PMID: 22506774 DOI: 10.1111/j.1365-2265.2012.04409.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/05/2012] [Accepted: 04/04/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To retrospectively analyse the effectiveness of bariatric surgery for hypothalamic obesity in patients with craniopharyngioma (CP). PATIENTS Patients who developed morbid obesity after surgery for CP and who underwent laparoscopic gastric banding (LAGB), laparoscopic sleeve gastrectomy or gastric bypass were included (n = 9). Patients with common obesity who underwent bariatric surgery served as controls (LAGB n = 40, sleeve gastrectomy n = 49 and gastric bypass n = 54). RESULTS CP was diagnosed during childhood or adolescence [median (range) 10 (1-21) years] and age at bariatric surgery was 17 [12-30] years. Six patients underwent gastric banding [median follow-up 5.5 years (range 1-9)], 4 had a sleeve gastrectomy [median follow-up 2 (0.4-4) years] and two patients had gastric bypass surgery (median follow-up 3 years). Three patients had more than one type of bariatric surgery. Different from controls, no weight loss was observed after LAGB or sleeve gastrectomy. The two patients who had gastric bypass surgery lost body weight comparable with controls. CONCLUSION With LAGB and sleeve gastrectomy, no significant loss of body weight was achieved in young adult patients with craniopharyngioma-associated morbid obesity.
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Affiliation(s)
- Dirk Weismann
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University of Wuerzburg, Wuerzburg, Germany.
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Nicholas DB, Chahauver A, Brownstone D, Hetherington R, McNeill T, Bouffet E. Evaluation of an online peer support network for fathers of a child with a brain tumor. SOCIAL WORK IN HEALTH CARE 2012; 51:232-245. [PMID: 22443403 DOI: 10.1080/00981389.2011.631696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study explored impacts of an online support network for fathers of a child with a brain tumor. Evaluation comprised pre/post-intervention questionnaires, content analysis of online network postings, and post-intervention qualitative interviews. Findings suggest that this intervention was beneficial to fathers. Positive effects on paternal coping were demonstrated, as were opportunities to grapple with difficult issues related to having a child with a brain tumor. Fathers recommended a combined resource of online and face-to-support, including the development of a support network with a larger participant base. Implications for practice are examined.
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Hovén EI, Lannering B, Gustafsson G, Boman KK. Persistent impact of illness on families of adult survivors of childhood central nervous system tumors: a population-based cohort study. Psychooncology 2011; 22:160-7. [DOI: 10.1002/pon.2067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Emma I. Hovén
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
| | - Birgitta Lannering
- University of Gothenburg; Department of Clinical Sciences, Pediatric Oncology; Gothenburg; Sweden
| | - Göran Gustafsson
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
| | - Krister K. Boman
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
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Han HR, Cho EJ, Kim D, Kim J. The report of coping strategies and psychosocial adjustment in Korean mothers of children with cancer. Psychooncology 2009; 18:956-64. [PMID: 19117279 DOI: 10.1002/pon.1514] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Parents of children with cancer must cope with multiple challenges over time. As most research on parental coping has been conducted in Western countries, little information is available on the parental experience of coping in non-Western countries. Using a new cultural sample of Korean mothers, this study describes their coping strategies. In addition, the association of particular coping patterns with mothers' report of psychosocial adjustment is investigated. METHODS A total of 200 Korean mothers of children with cancer participated in the study. Coping strategies were measured by the Coping Health Inventory for Parents in the following three categories: Maintaining Family Integration and an Optimistic Outlook for the Situation, Seeking Social Support, and Seeking Information. Maternal psychosocial adjustment was measured by psychological distress, family relationship, and social relationship subscales from the Psychosocial Adjustment to Illness Scale. RESULTS Korean mothers reported coping strategies related to Maintaining Family Integration and an Optimistic Outlook for the Situation as being most helpful. More frequent use of coping pattern, Maintaining Family Integration and an Optimistic Outlook for the Situation, and less frequent use of coping pattern, Information-Seeking were significantly associated with lower psychological distress and better family relationship after children's medical and maternal characteristics were controlled for. Coping pattern, Seeking Social Support was only predictive of social relationships. CONCLUSIONS This study suggests that culture may play a significant role in the report of coping among Korean mothers. Future studies should consider culturally preferred coping methods and available resources as they relate to different adjustment outcomes.
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Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University, School of Nursing, Baltimore, MD, USA.
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Jackson AC, Enderby K, O'Toole M, Thomas SA, Ashley D, Rosenfeld JV, Simos E, Tokatlian N, Gedye R. The Role of Social Support in Families Coping with Childhood Brain Tumor. J Psychosoc Oncol 2009; 27:1-24. [DOI: 10.1080/07347330802614634] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Caldarelli M, Massimi L, Tamburrini G, Cappa M, Di Rocco C. Long-term results of the surgical treatment of craniopharyngioma: the experience at the Policlinico Gemelli, Catholic University, Rome. Childs Nerv Syst 2005; 21:747-57. [PMID: 15995885 DOI: 10.1007/s00381-005-1186-5] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Craniopharyngioma (CP) is the most common intracranial non-glial tumour observed in pediatric age. Although histologically benign and amenable to surgical treatment, its location and relation with vital nervous and vascular structures makes the feasibility of a radical resection difficult even in the microneurosurgery era. Beside the difficulties experienced when performing tumour resection, post-operative complications, such as endocrinological imbalance, represent another point that makes CP total excision a challenge. In order to avoid such complications, some authors have suggested to renounce to radical resection and to rely on post-operative radiation therapy to minimise the risk of residual tumour progression. METHODS We report our experience with 52 children and adolescents operated on for CP at the Department of Pediatrics, Section of Pediatric Neurosurgery, Catholic University Medical School, Rome, between January 1985 and December 2002. The study included 14 children <5 years old (five less than 2 years of age), 25 between 6 and 10 years old, and 13 more than 10 years old. The most common presenting signs were related to endocrinological imbalance (35 cases), increased intracranial pressure (32 cases), and to a lesser extent, visual compromise (17 cases). Concerning location, CP was intrasellar in three cases; sellar/suprasellar with prominent prechiasmatic growth in 24 cases; retrochiasmatic/3rd ventricular in 14 cases, and giant (with an extension into the middle and/or posterior cranial fossae) in 11 cases. The tumour was managed by means of a single surgical approach in 47 cases and with a two-stage operation in the remaining five cases. In 11 cases of intrasellar or intra/suprasellar midline location, the first surgical approach was done through the transsphenoidal route (which represented the first step of a staged operation in five instances); in the remaining 41 patients, craniotomy was the first surgical procedure. Radical tumour resection was achieved in 40 cases, subtotal (only small tumour remnants adherent to the carotid arteries, 3rd ventricle floor or visual pathways) in nine, and only partial in the remaining three cases RESULTS Histology demonstrated the adamantinous variant in all cases. Two surgical deaths were recorded in this series (both following a transsphenoidal approach): one secondary to uncontrollable intra-operative bleeding from the carotid artery, and the other to fulminating bacterial meningoencephalitis. Morbidity included endocrinological disturbances, namely hypopituitarism and diabetes insipidus, in more than 80% of cases, worsening of pre-operative visual deficit in six cases, and transitory neurological deficits in five cases. One late death was recorded 2 years after surgery, secondary to electrolytic imbalance although favoured by a major head trauma with subacute subdural haematoma. Nine recurrences occurred 1-8 years after surgery (three true recurrences, and six re-growths of incompletely resected tumours) that required re-operation. Twelve patients underwent radiotherapy, six after an initially incomplete tumour resection and six following relapse. One patient presented with a malignant thalamic glioma 8 years after radiotherapy. At long-term follow-up, all survivors showed good clinical condition, even though approximately 60% relied on hormone replacement, and some patients presented obesity. Diabetes insipidus has subsided in about 80% of the cases; visual deficits improved or remained stable, whereas post-operative neurological deficits subsided in all but one patient. CONCLUSION In our experience, radical resection of CP represented the first and almost unique treatment modality. Although not insignificant, post-operative mortality and morbidity do not seem to represent a major contraindication in attempting a radical tumour resection whenever possible. On the other hand, extensive hypothalamic involvement should suggest a less aggressive attitude.
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Affiliation(s)
- M Caldarelli
- Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy.
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Marchal JC, Klein O, Thouvenot P, Bernier V, Moret C, Chastagner P. Individualized treatment of craniopharyngioma in children: ways and means. Childs Nerv Syst 2005; 21:655-9. [PMID: 15952028 DOI: 10.1007/s00381-005-1211-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Medium- and long-term prognosis of craniopharyngioma is overwhelmed by the risks of hypothalamic and visual impairment. This problem has been underestimated for a long time because the major concern for the neurosurgeon was the risk of recurrences, their best prevention being thought to be complete tumour resection. Today, we know that radical surgery not only is not an absolute guarantee against recurrences but also can cause hypothalamic and visual complications. METHODS The authors suggest that instead of complete removal, the first choice treatment should be, when possible, a less aggressive, multistaged and personalized treatment. In this perspective they focus on other therapeutic methods: endocavity treatment of cysts with rhenium-186, triconformational radiotherapy, radiosurgery, and widespread use of the trans-sphenoidal approach. CONCLUSIONS These simple methods should reduce the risks of visual aggravation and metabolic syndrome.
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Affiliation(s)
- J C Marchal
- Unit of Paediatric Neurosurgery, Hôpital Central, 27 avenue de Lattre de Tassigny, 54000, Nancy, France.
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