Craniopharyngiomas of childhood: the CHLA experience

Sosa, Iván J.; Krieger, Mark D.; McComb, J. Gordon

doi:10.1007/s00381-005-1225-2

Cited by 36 publications

(22 citation statements)

References 9 publications

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“…While there was no operative mortality in our series, the OS rate (69%) was lower than the reported rate of longterm survival of over 90% in the modern era 3,14,15,17,22,23,36,42,49,51,52,58,59,63,69,77,84,95 and significantly worse than the OS rate in the 60 children with smaller tumors in our series (91%). However, subgroup analysis revealed most of the difference was due to the extremely poor survival rate in children with previously treated (recurrent) giant tumors (33%).…”

Section: Surgical Success and Functional Outcomecontrasting

confidence: 85%

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 Outcomecontrasting

confidence: 85%

Surgical management of giant pediatric craniopharyngiomas

Elliott¹,

Wisoff

2010

PED

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“…Furthermore, the rate of recurrence of all craniopharyngiomas increases with the duration of follow-up. Although many studies report that most local recurrences occur in the first 3-4 years following resection, 13,16,22,30,50,56,60,62,63 the mean time to recurrence for the reported cases of ectopia in the literature is much longer (mean 6.8 years). Thus, long-term imaging and follow-up are equally important as frequent serial imaging in the years immediately following resection, when the majority of local recurrences arise.…”

Section: Discussionmentioning

confidence: 99%

“…5,8,10,12,13,16,22,26,27,37,38,44,50,55,56,60,62,63 Due to the benign nature of the epithelial rests that comprise craniopharyngiomas on histopathological studies, tumor recurrence usually occurs locally at the primary site or in regions immediately adjacent. Remote recurrence following surgery is reported as a rare phenomenon, and only 28 cases have been reported in the literature (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Their findings are consistent with those of other authors, who also report no instances of ectopic recurrence. 26,38,50 Local and ectopic recurrences have been reported to occur as late as 36 27 and 26 years, 29 respectively, after initial resection. Furthermore, the rate of recurrence of all craniopharyngiomas increases with the duration of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…39,45,46,58,60 Despite their benign histopathological characteristics, their clinical course is often rather malignant, and recurrence of craniopharyngiomas is one of the most common complications of treatment, occurring in 0-57% of patients following complete resection. 5,8,10,12,13,16,17,22,26,27,30,37,38,44,50,55,56,60,62,63 Although most recurrences occur locally-in or adjacent to the suprasellar cistern-ectopic recurrence of craniopharyngioma can occur in the presence or absence of suprasellar disease. Two common patterns of ectopia are along the surgical tract 4,7,8,18,19,23,25,[33][34][35]43,47,55 and dissemination via the CSF into the cortical subarachnoid, 3,6,7,15,21,24,29,30,42,…”

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confidence: 99%

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Surgical treatment of ectopic recurrence of craniopharyngioma

Elliott¹,

Moshel²,

Wisoff

2009

PED

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Local recurrence following radical resection is one of the most common complications of pediatric craniopharyngioma. Only 28 cases of ectopic recurrence of craniopharyngioma have been reported in the literature, and only 13 cases occurred in patients originally treated as children. In this consecutive series of 86 children who underwent radical resection of primary and recurrent craniopharyngiomas, 4 patients (4.7%) experienced ectopic tumor recurrence, accounting for 27% of all recurrences after gross-total resection. The authors report on the successful surgical treatment of these 4 patients and the impact of ectopic craniopharyngioma recurrence on survival.

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