Craniopharyngioma: A lower-middle-income-country epidemiology

Individual management and prognostic assessment for long-term outcomes using a novel classification system of craniopharyngiomas: a retrospective study of single institution

PURPOSE

This study aims to propose a classification system to more accurately understand the features and nature of different CPs, to investigate the correlation between different topographies of CPs and their surgical outcomes.

METHODS

A retrospective analysis was conducted on 91 surgically resected CPs. They were categorized into six types based on their location and origin. Simultaneously, the patients were divided into four categories based on the degree of pituitary stalk(PS) preservation postoperatively. Statistical analysis was performed to compare the variables among the different tumor type groups.

RESULTS

A total of 91 patients were included. The follow-up data for 59 cases were complete. Tumor volume varied significantly, with the suprasellar-third ventricle type II and ectopic type exhibiting larger volumes (P < 0.05). The choice of surgical approach differed significantly. The recurrence rates were significantly lower for the intrasellar-suprasellar type, suprasellar-third ventricle type II, and third ventricle type (P < 0.05). Patients with intra-stalk tumor growing pattern have a lower degree of PS preservation than those with peri-stalk pattern (P < 0.05). Patients' BMI after surgery was generally higher than before, and the incidence of pituitary dysfunction increased significantly. The proportion of long-term endocrine dysfunction was significantly higher in patients with complete disconnection of PS compared to those with preservation of the PS(P < 0.05).

CONCLUSIONS

This system holds significant importance in foretelling the rates of recurrence, alterations in postoperative body weight, long-term endocrine status, and potential complications. Furthermore, this study identified preoperative pituitary function status and specific surgical approaches as potential protective factors.

Pediatric craniopharyngioma: a 20-year study on epidemiological features, clinical presentation, and survival outcomes in a tertiary care center from LMIC

INTRODUCTION

Craniopharyngioma constitutes approximately 10% of primary brain tumors in children. It can cause considerable morbidity and mortality due to the local aggressiveness of the tumor itself or its management affecting the hypothalamus-pituitary axis and optic pathway involvement. There is very scarce data available from LMIC which makes the management controversial where multidisciplinary teams are already not available in most of the centers. This is a single-center cross-sectional retrospective review of 20-year record of 49 patients with craniopharyngioma treated between 2001 and 2020 at Aga Khan University Hospital, a tertiary care center in Karachi, Pakistan.

METHODS

We have assessed the epidemiological data of children presenting with the diagnosis of craniopharyngioma, treatment modalities used, and neurological, endocrine, and hypothalamic complications in these patients. The assessment involved a retrospective review of medical records and medical follow-up.

RESULTS

Out of a total of 49 patients, 26 (53%) were male, and 23 (46.9%) were female. The mean age was 9.5 years (SD ± 4.5 years). Most common symptoms at initial presentation were headache 41 (83.6%), visual deficit 40 (81.6%), nausea and vomiting 26 (53%), and endocrine abnormalities 16 (32%). Treatment modalities used at our center include gross total resection 11 (22%) and subtotal resection 38 (77%) out of total, while 6 (12.2%) patients received intracystic interferon. Histopathologic findings of the majority of patients (40 (81%)) revealed an adamantinomatous type of tumor. Only 23 (46.9%) children followed in clinic post-op. Median follow-up after craniopharyngioma presentation was 5 years (± 2.1 SD, range: 2-10 years). Pituitary hormone deficiencies (98%) and visual disturbances (75%) were the most common long-term health conditions observed.

CONCLUSIONS

Since pituitary hormone deficiencies and visual disturbance were the most common long-term health conditions observed in our study, these patients require a multidisciplinary team follow-up to improve their quality of life.