Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas

Minniti, Giuseppe; Saran, Frank; Traish, D.; Soomal, Rubin; Sardell, S.; Gonsalves, A.; Ashley, S.; Warrington, Jim; Burke, K.; Mosleh-Shirazi, Mohammad Amin; Brada, Michael

doi:10.1016/j.radonc.2006.11.005

Cited by 145 publications

(90 citation statements)

References 57 publications

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“…1,2,16 Other options for managing craniopharyngiomas include stereotactic aspiration and Ommaya reservoir insertion for continuous aspiration, conservative resection followed by radiosurgery, radiotherapy, and intracavitary treatment for cystic tumors with radioisotope or chemotherapeutic agents. 14,20,27,29,30 However, the long-term consequences of these methods as primary treatment are unclear, and they are not without complications. 1,11,12,15,17,21,[24][25][26] …”

Section: Approach-related Complicationsmentioning

confidence: 99%

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Gerganov¹,

Metwali²,

Samii³

et al. 2014

JNS

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Object. An extensive craniopharyngioma is a tumor that extends into multiple compartments (subarachnoid spaces) and attains a size larger than 4 cm. A wide spectrum of approaches and strategies has been used for resection of such craniopharyngiomas. In this report the authors focused on the feasibility and efficacy of microsurgical resection of extensive craniopharyngiomas using a frontolateral approach.Methods. A retrospective analysis was performed on 16 patients with extensive craniopharyngiomas who underwent operations using a frontolateral approach at one institution. The preoperative and postoperative clinical and radiological data, as well as the operative videos, were reviewed. The main focus of the review was the extent of radical tumor removal, early postoperative outcome, and approach-related complications.Results. Gross-total resection of craniopharyngioma was achieved in 14 (87.5%) of 16 cases. Early after surgery (within 3 months), 1 patient showed improvement in hormonal status, while in the remaining 15 patients it worsened. No major neurological morbidity was observed. Two patients experienced temporary psychotic disorders. Visual function improved in 6 patients and remained unchanged in 9. One patient experienced a new bitemporal hemianopsia. Three patients with features of short-term memory disturbances at presentation did show improvement after surgery. There were no deaths or significant approach-related morbidity in this patient series. Only 1 patient required revision surgery for a CSF leak.Conclusions. The safe and simple frontolateral approach provides adequate access even to extensive craniopharyngiomas and enables their complete removal with a reasonable morbidity and approach-related complication rate. (http://thejns.org/doi/abs/10.3171/2013.9.JNS122133) Key worDs • extensive craniopharyngioma • frontolateral • giant craniopharyngioma • microsurgery • outcome • oncology • skull base 559Abbreviations used in this paper: ACA = anterior cerebral artery; ACoA = anterior communicating artery; CPA = cerebellopontine an gle; GTR = gross-total resection; ICA = internal carotid artery; PCoA = posterior communicating artery. * Drs. Fahlbusch and M. Samii share senior authorship of this work.

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Section: Approach-related Complicationsmentioning

confidence: 99%

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Gerganov¹,

Metwali²,

Samii³

et al. 2014

JNS

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“…Radiotherapy for giant tumors would require a very large target volume and/or total dosage, both major risk factors for increased side effects of cranial irradiation. 18,24,55,65,66 Furthermore, Minniti et al 53 reported a 28% rate of cyst enlargement requiring aspiration following RT; the occurrence of this complication may indeed be higher for larger, predominantly cystic tumors.…”

Section: Treatment Options For Giant Craniopharyngiomasmentioning

confidence: 99%

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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“…Survival rates among pa tients treated with limited resection followed by irradia tion are similar to results after radical resection. 12,25,44,65,68,85,86,94,95,98,113,116,123,125 The risk-benefit analysis of reopera tion versus other salvage therapies, however, is unclear. Several authors have reported increased rates of mortal ity, morbidity, decreased chance of achieving GTR, and decreased OS after reoperation.…”

mentioning

confidence: 99%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

163

148

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Object Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. Methods A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. Results All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size ≥ 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. Conclusions In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.

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Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas

Cited by 145 publications

References 57 publications

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Surgical management of giant pediatric craniopharyngiomas

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

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