A new approach to inoperable craniopharyngiomas

Trippi, Anthony C.; Garner, John T.; Kassabian, John T.; Shelden, C. Hunter

doi:10.1016/0002-9610(69)90133-0

Cited by 28 publications

(11 citation statements)

References 6 publications

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“…68 Likewise, operative mortality for pediatric craniopharyngiomas has steadily declined with time. 50,88,94,95 Nevertheless, most authors continue to report increased mortality, 94 morbidity, 14,22,94 and tumor recurrence 14,22,29,34,83,91 and decreased extent of resection 14,16,23,27,28,39,46,74,86 for larger tumors. Yaşargil et al 94 reported a direct correlation between increasing size and higher operative morbidity and mortality.…”

Section: Surgical Success and Functional Outcomementioning

confidence: 99%

“…Prior work by our group demonstrated decreased overall survival (OS) in patients with larger craniopharyngiomas. 19 Other authors report increased mortality, 94 increased neurological and hypothalamic morbidity, 14,22,94 decreased extent of resection and local disease control, 14,16,23,27,28,39,46,68,74,86,91 and higher rates of tumor recurrence 14,22,29,34,83,91 in larger tumors. Some authors, however, report tumor size or volume to have no impact on extent of resection, 2,4,50,88,95 rate of recurrence 49,63 or hypothalamic morbidity.…”

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confidence: 99%

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Surgical management of giant pediatric craniopharyngiomas

Elliott¹,

Wisoff

2010

PED

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Object Prior work by the authors' group and reports of other authors suggest worse functional outcomes and decreased survival in children with larger craniopharyngiomas. The purpose of this study was to assess the oncological, endocrinological, and functional outcomes in children who underwent radical resection of giant craniopharyngiomas (defined as 5 cm or greater in largest diameter). Methods Between 1986 and 2006, 26 children under the age of 18 (14 boys, 12 girls; mean age 10.5 years) underwent radical resection of giant craniopharyngiomas performed by the senior author. Data were retrospectively collected to assess the outcome of surgical treatment. Results Twenty (77%) of 26 patients underwent gross-total resection (GTR) confirmed by intraoperative inspection and postoperative imaging. All primary tumors (17 of 17) and 3 (33%) of 9 recurrent tumors were treated with GTR. There was no operative mortality, and 18 of 26 patients (69%) were alive at a mean follow-up of 8.9 years (median 9.3 years). Disease control was achieved in 21 (84%) of the 25 patients followed up for more than 6 months and was more successful in patients who underwent GTR (95%) than in those who underwent STR (50%, p = 0.03). New-onset diabetes insipidus (DI) occurred in 63.2% of patients (73% of patients had DI postoperatively). New or worsened deficits in visual acuity and visual fields occurred in 16% and 28%, respectively, of the 25 patients for whom postoperative visual data were available. Five patients (19%) experienced significant, permanent neurological deficits, and 5 (19%) had mild to moderate deficits. New or worsened hypothalamic disturbance occurred in 35% and 22% of patients, respectively, but obesity developed in only 15%. Conclusions In this retrospective series, radical resection of giant craniopharyngiomas in children was found to lead to excellent rates of disease control with acceptable or good functional outcomes but slightly higher rates of neurological complications compared with rates in patients with smaller tumors. Radical resection is less successful in recurrent tumors that reach very large sizes, especially previously irradiated tumors, with resultant diminished survival.

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Section: Surgical Success and Functional Outcomementioning

confidence: 99%

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confidence: 99%

Surgical management of giant pediatric craniopharyngiomas

Elliott¹,

Wisoff

2010

PED

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“…Internal ir radiation for cystic craniopharyngioma has been uti lized in the past providing inhibition of cyst reexpan sion. Radioactive colloid chromic phosphate, gold-198, or yttrium-90, which emit (l-particles, were used [39,54,55], Kobayashi et al [54] reported excellent response with reduction of cyst fluid retention and/or collapse of the cyst over a follow-up period of 13-156 months. Care ful dosimetric calculation and avoidance of spill or leak of radioisotope should be monitored.…”

Section: Treatment Of Recurrent Tumormentioning

confidence: 99%

“…Thus, a majority of recent authors recommend radical subtotal resection and radi ation therapy if attempted total resection is not possible [8,24,26,[32][33][34][35][36][37][38]. However, some recommend only biopsy and cyst drainage followed by radiation therapy instead of attempting radical total or subtotal resections [21,25,31,[39][40][41],…”

Section: Radiation Therapymentioning

confidence: 99%

Management of Craniopharyngiomas in Children

Tomita

1988

Pediatr Neurosurg

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Craniopharyngiomas are histologically benign neoplasms occurring in the intra- and suprasellar region. Their location and close relation with visual pathways, hypothalamus and major basal vessels may cause difficulty in resecting these tumors without surgical complications. Radiotherapy after limited resection of craniopharyngiomas has been advocated by some investigators while others contend radical resections by means of advanced surgical techniques afford better outcome of patients. Although optimal treatment is yet to be defined, the review of our institutional experience and the critical analysis of the literature show that radiation therapy may be effective but not curative. It is recommended that surgeons should make every effort to effect total excision at the initial operation.

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“…Trippi et al [48] suggested that inoperability be deter mined by any one of the following conditions: prefixed optic chiasm; marked upward extension into the floor of the third ventricle; extensive unilateral or bilateral tempo ral lobe involvement, and firm adhesions between the tumor capsule, hypothalamus and optic chiasm. Accord ingly, they recommended the injection of radioactive coloidal chromic phosphate into the cystic portion of the tumor.…”

Section: Review Of Operative Treatment Of Craniopharyngiomamentioning

confidence: 99%