Cyst fenestration and Ommaya reservoir placement in endoscopic transcortical transventricular approach for recurrent suprasellar cystic craniopharyngioma without ventriculomegaly

Ndukuba, Kelechi Onyenekeya; Ogiwara, Toshihiro; Nakamura, Takuya; Abe, Daishiro; Ichinose, Shunsuke; Horiuchi, Tetsuyoshi; Ohaegbulam, Samuel C.; Hongo, Kazuhiro

doi:10.1016/j.jocn.2019.12.060

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…Although not as well described, this approach has been applied in the adult population, particularly for patients with tumors deemed to be highly unresectable or with medical co-morbidites, precluding aggressive surgical intervention. These studies include description of endoscopic cyst fenestration with Ommaya reservoir placement with or without radiotherapy as an effective first-line treatment strategy in these patients [65,[71][72][73][74][75]. As such, this treatment strategy may be particularly relevant for adult patients with cystic craniopharyngiomas who present with concomitant hydrocephalus or who are not candidates for maximal surgical resection.…”

Section: Stereotactic Cyst Decompressionmentioning

confidence: 99%

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

Hong

Omay

2022

Current Oncology

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Craniopharyngiomas are rare, benign primary brain tumors that arise from remnants of the craniopharyngeal duct epithelium within the sellar and suprasellar region. Despite their benign biology, they may cause significant morbidity, secondary to involvement of nearby eloquent neural structures, such as the pituitary gland, hypothalamus, and optic apparatus. Historically, aggressive surgical resection was the treatment goal to minimize risk of tumor recurrence via open transcranial midline, anterolateral, and lateral approaches, but could lead to clinical sequela of visual, endocrine, and hypothalamic dysfunction. However, recent advances in the endoscopic endonasal approach over the last decade have mostly supplanted transcranial surgery as the optimal surgical approach for these tumors. With viable options for adjuvant radiation therapy, targeted medical treatment, and alternative minimally invasive surgical approaches, the management paradigm for craniopharyngiomas has shifted from aggressive open resection to more minimally invasive but maximally safe resection, emphasizing quality of life issues, particularly in regards to visual, endocrine, and hypothalamic function. This review provides an update on current multi-modal approaches for craniopharyngiomas, highlighting the modern surgical treatment paradigm for this disease entity.

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Section: Stereotactic Cyst Decompressionmentioning

confidence: 99%

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

Hong

Omay

2022

Current Oncology

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“…Similarly, the fluid subtraction favors RT by removing a not radiosensitive component of the tumor and by reducing the irradiation field. Finally, such multimodal management may involve neuroendoscopy both for fluid aspiration and for tumor removal in case of AC mainly involving the third ventricle [ 151 ].…”

Section: Introductionmentioning

confidence: 99%

Adamantinomatous craniopharyngioma: evolution in the management

Massimi,

Palombi,

Musarra

et al. 2023

Childs Nerv Syst

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Background In spite of the continuous progresses in pediatric neurosurgery, adamantinomatous craniopharyngioma (AC) remains a challenging tumor due to its proximity to optic pathways, pituitary gland, hypothalamus, and Willis’ circle, which can result in significant endocrine, cognitive, and neurological morbidity after treatment with subsequent impact on the patient’s quality of life (QoL). The relevance that QoL has today explains the changes in the management of AC observed over the time. The goal of the present article is to provide a historical background, to show the milestones in the changes of the AC treatment, and to analyze the current main options to manage such a challenging tumor. Material and methods The pertinent literature has been reviewed. Moreover, a comparison between the past and recent personal series is reported. Results Three main eras have been identified. The first (named Cushing era) was characterized by the need to realize a harmless surgery and to define the best way to approach AC; the second (microscope era) was characterized by a tremendous technical and technological development, with remarkable results in term of safe tumor resection and control but relatively poor QoL outcomes; and the third one (current period) is characterized by an increasing integration between surgery and adjuvant treatments, with relatively minor tumor control but significant improvement of QoL (comparable overall survival). The authors’ experience reflects these changes. Two groups of children were compared: 52 cases (mean follow-up: 17.5 years) belong to the historical series (group 1, 1985–2003, aggressive surgical management) and 41 (mean follow-up: 8.5 years) to the current one (Group 2, 2004–2021, integrated management). No significant differences between the two groups were detected about recurrence rate, surgical mortality, and overall survival. However, Group 2 showed significant lower rates of postoperative panhypopituitarism, obesity, and visual deterioration. Conclusions Radical surgery allows for a good AC control with a low rate of recurrence but high risk of permanent morbidity. Despite the greater number of recurrences and surgeries, the more conservative policy, based on a combination of treatments, seems to provide the same tumor control with a better QoL. The advances in trans-nasal and trans-ventricular endoscopy, in proton therapy and in the management of the AC cyst are the main factors that allowed such an improvement.

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