Editorial. Craniopharyngioma classification

Abstract

raniopharyngiomas (CPs) are among the most surgically complex brain tumors due to their deep location and intimate involvement with critical neural and vascular structures. Furthermore, injury to the adjacent hypothalamus, infundibulum, pituitary gland, optic apparatus, or vasculature can have devastating consequences including hypothalamic obesity, autonomic dysregulation, panhypopituitarism, blindness, and major strokes. Their location, arising from the sella up through the third ventricle, can be accessed via multiple surgical approaches. Broadly, the approaches include variants of the transcallosal, transsylvian, subfrontal, and endonasal approach, all of which are viable options for CP resection. Determining the ideal approach has been a source of lively debate among neurosurgeons for many years, and as such, several classification systems based on surgeon experience have been proposed, including the classification by Fan et al. in the current issue. 1 The ideal classification system is one that would predict functional outcomes, extent of resection, and recurrence rates, based on tumor characteristics, patient anatomy, and approach. This would allow the neurosurgeon to select the approach that would provide the best outcome for each patient's unique tumor. The first classification was put forward in 1990 by Gazi Yaşargil based on his microsurgical experience with 144 CPs (Table 1). 2 His classification system was based on the relationship of the tumor with the surrounding anatomical structures, foremost of which were the diaphragma sellae, the tuber cinereum/floor of the third ventricle, and the third ventricle/hypothalamus. The primary challenge during this era was in preoperative diagnostic imaging to understand relationships of the tumor with these structures, because MRI was a relatively new technology at the time. Nevertheless, this anatomical relationship was key to guiding the surgical approach. The pterional approach was used most frequently by Yasargil because it allowed early identification of the stalk, anterior circulation, and protection of the optic chiasm. When tumors extended superiorly in the third ventricle, he would combine the pterional with a transcallosal approach. He

The Price of Success—The Long-Term Outcomes of Children with Craniopharyngioma—Two Institutions’ Experience

“…As very good survival is observed in over 90% of patients with this low-grade tumor, the goal is to avoid the long-term morbidity [1,3]. A preoperative radiological grading system evaluating hypothalamic involvement has been developed for pediatric patients with the aim to optimize treatment strategy [1,3,11,32,[64][65][66][67][68]. Several classification systems based on surgeon experience have been proposed and commented by Magill et al [64].…”

“…Late consequences include hypothalamic obesity, hypopituitarism, worsening of psycho-social functioning, and decline in quality of life [3,[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. The rate of neurosurgical complication was observed in many studies as high as 90%, even with improved surgical approaches [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64]. There are still controversies regarding the optimum management as only two prospective trials led by the German group were completed so far [5,58].…”

Craniopharyngioma

“…CP has been anatomically classified based on the relationship of the tumor to the sella, diaphragma sellae, optic chiasm, stalk (infundibulum), and third ventricle DOI: http://dx.doi.org/10.5772/intechopen.106635 mainly to assist in planning optimal surgical approach [21,23]. The first classification was introduced by Gazi Yaşargil based on his microsurgical experience with CPs [23].…”

“…CP has been anatomically classified based on the relationship of the tumor to the sella, diaphragma sellae, optic chiasm, stalk (infundibulum), and third ventricle DOI: http://dx.doi.org/10.5772/intechopen.106635 mainly to assist in planning optimal surgical approach [21,23]. The first classification was introduced by Gazi Yaşargil based on his microsurgical experience with CPs [23]. According to his scheme, type A is confined within the sella (intrasellar infra diaphragmatic); type B is both intra-and suprasellar, infra-and supradiaphragmatic; type C is supradiaphragmatic, parachiasmatic, and extraventricular; type D is intraand extraventricular; type E is paraventricular with respect to the third ventricle; type F is purely intraventricular [24].…”

“…The main limitation of the pterional approach is the tumor extending into the upper part of the third ventricle and retrosellar region [46]. When tumors extend superiorly in the third ventricle, the pterional approach can be combined with the transcallosal approach because the pure pterional approach may be insufficient for proper dissection of the superior and posterior portions of the tumor within the third ventricle [23,24]. CPs are usually subarachnoid tumors; therefore, they may be easily dissected from the surrounding structures covered with their own arachnoid layers.…”