Intracystic bleomycin for cystic craniopharyngiomas in children

Si, Zhongzhou; Yuan, Fang; Cai, Bo Wen; Xu, Jian; You, Chao

doi:10.1002/14651858.cd008890.pub4

Cited by 32 publications

(20 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Mainly for recurrent single cystic CP, intracavitary instillation of sclerosing substances such as interferon-α is a treatment of choice [40,41]. Due to neurotoxicity in the case of leakage, bleomycin instillation is obsolete [42]. Systemic interferon alpha treatment has not been proven to be efficient for the prevention of solid CP progression.…”

Section: Instillation Of Sclerosing Substances For Cystic Cpmentioning

confidence: 99%

The Diagnosis and Treatment of Craniopharyngioma

Müller

2019

Neuroendocrinology

108

View full text Add to dashboard Cite

Craniopharyngioma (CP) is a rare embryonic malformation of the sellar/parasellar region with a low histological grade. Clinical manifestations are related to hypothalamic/pituitary deficiencies, visual impairment, and increased intracranial pressure. Recent insight into the molecular pathogenesis of CP opens new perspectives on targeted therapy in papillary CP harboring BRAF-V600E mutations. Further research to elucidate pathogenic mechanisms and hopefully prevent hypothalamic involvement of CP is warranted. If the tumor is favorably localized, the therapy of choice is complete resection, with care taken to preserve the optical and hypothalamic functions. In patients with unfavorable tumor localization (i.e., hypothalamic involvement), the recommended therapy is a limited hypothalamus-sparing surgical strategy followed by local irradiation. Surgical treatment strategies should be based on a multidisciplinary approach involving experienced teams. Centralizing the treatment of CP in experienced "centers of excellence" and multicenter-based networks for reference assessments should be considered to assure a high standard of treatment quality. CP recurrence and progression are frequent. Irradiation has proven effective in reducing recurrences and progression. Proton beam therapy, available in a wider range in the near future, will help to avoid radiooncological side effects. Anatomical involvement and/or surgical lesions of posterior hypothalamic areas can result in serious sequelae that compromise quality of life (QoL), such as hypothalamic obesity and psychopathological symptoms. Novel insights into neuropsychological sequelae after CP occurrence should be the basis for the development of therapeutic neuropsychological interventions. CP should be managed as a frequently chronic disease, providing ongoing care of pediatric and adult patients' clinical and QoL consequences by experienced multidisciplinary teams.

show abstract

Section: Instillation Of Sclerosing Substances For Cystic Cpmentioning

confidence: 99%

The Diagnosis and Treatment of Craniopharyngioma

Müller

2019

Neuroendocrinology

108

View full text Add to dashboard Cite

show abstract

“…36 All these make the EEA a challenge to perform when dealing with pediatric craniopharyngiomas. 4,44,49,62 Tatreau et al 58 and Scuderi et al 54 have shown that the pneumatization pattern follows a strict caudal-to-rostral pattern and lateral direction. The aeration of the sphenoid sinus is the direct determinant of the drilling distance and can help establish the best entry point to access the skull base.…”

Section: Pediatric Eeamentioning

confidence: 99%

“…1,10,11,12,49 Intracystic bleomycin, interferon, and radioactive agents have also been administered in an attempt at reducing the recurrence risk. 4,12,62 Recently, BRAF inhibitors have been demonstrated to show effectiveness against the BRAF-mutated papillary craniopharyngiomas. Unfortunately, almost all pediatric craniopharyngiomas are CTNNB1-mutated adamantinomatous type.…”

mentioning

confidence: 99%

Suprasellar and recurrent pediatric craniopharyngiomas: expanding indications for the extended endoscopic transsphenoidal approach

Alalade¹,

Ogando‐Rivas²,

Boatey³

et al. 2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEThe expanded endonasal endoscopic transsphenoidal approach has become increasingly used for craniopharyngioma surgery in the pediatric population, but questions still persist regarding its utility in younger children, in recurrent and irradiated tumors, and in masses primarily located in the suprasellar region. The narrow corridor, incomplete pneumatization, and fear of hypothalamic injury have traditionally relegated this approach to application in older children with mostly cystic craniopharyngiomas centered in the sella. The authors present a series of consecutive pediatric patients in whom the endonasal endoscopic approach was used to remove craniopharyngiomas from patients of varied ages, regardless of the location of the tumor and previous treatments or surgeries, to ascertain if the traditional concerns about limitations of this approach are worth reevaluatingMETHODSEleven consecutive pediatric patients (age ≤ 18 years) underwent surgery via an endoscopic transsphenoidal approach at NewYork-Presbyterian/Weill Cornell Medical Center from 2007 to 2016. The authors recorded the location, consistency, and size of the lesion, assessed for hypothalamic invasion radiographically, calculated skull base measurements, and assessed parameters such as extent of resection, visual function, endocrinological function, weight gain, and return-to-school status.RESULTSThe average age at the time of surgery was 7.9 years (range 4–17 years) and the tumor sizes ranged from 1.3 to 41.7 cm3. Five cases were purely suprasellar, 5 had solid components, 4 were reoperations, and 5 had a conchal sphenoid aeration. Nevertheless, gross-total resection was achieved in 45% of the patients and 50% of those in whom it was the goal of surgery, without any correlation with the location, tumor consistency, or the age of the patient. Near-total resection, subtotal resection, or biopsy was performed intentionally in the remaining patients to avoid hypothalamic injury. Anterior pituitary dysfunction occurred in 81.8% of the patients, and 63.3% developed diabetes insipidus . Two patients (18%) had a greater than 9% increase in body mass index. Visual function was stable or improved in 73%. All children returned to an academic environment, with 10 of them in the grade appropriate for their age. There was a single case of each of the following: CSF leak, loss of vision unilaterally, and abscess.CONCLUSIONSThe endoscopic transsphenoidal approach is suitable for removing pediatric craniopharyngiomas even in young children with suprasellar tumors, conchal sphenoid sinus, recurrent tumors, and tumors with solid components. The extent of resection is dictated by intrinsic hypothalamic tumor invasiveness rather than the approach. The endoscopic transsphenoidal approach affords the ability to directly inspect the hypothalamus to determine invasion, which may help spare the patient from hypothalamic injury. Irrespective of approach, the rates of postoperative endocrinopathy remain high and the learning curve for the approach to a relatively rare tumor is steep.

show abstract

“…Reported complications related with this treatment include bleomycin leakage and toxicity, vasculopathy [98] and fatal toxic effects [99]. However, importantly, Zhang [14] and colleagues argued the rational use of intracystic bleomycin due to lack of RCTs, quasi-randomised trials or CCTs of the treatment of cystic CPs in children.…”

Section: Cp Recurrence and Gamma Knife Surgery (Gks)mentioning

confidence: 99%

“…While the management of primary CPs is challenging, the treatment of recurrent CPs is even more exacting and variable [5] [6]. Currently, treatment of recurrent CP involves gross-total resection oriented surgical removal, in combination with or without adjuvant radiotherapy [7] [8], gamma knife surgery [9] [10] [11], stereotactic intracavitary brachytherapy [12], ommaya reservoir placement [13], intratumoral bleomycin [14] and systematic chemotherapy [15]. However, the role of clinical and histopathological features that might be predictors of recurrence/regrowth has not been clearly elucidated in published literature [16].…”

Section: Introductionmentioning

confidence: 99%

Clinical, Pathological and Surgical Risk Factors Associated with Craniopharyngioma Recurrence: A Literature Review

Lubuulwa¹,

Miao²,

Liu³

et al. 2019

OJMN

View full text Add to dashboard Cite

Objective: This review article attempts to examine and provide an overview of the risk factors associated with craniopharyngioma recurrence. Methods: A literature review of articles relating to the recurrences of craniopharyngioma and the clinical, molecular prognostic indicators of recurrence and treatment outcomes was performed retrospectively. Results: A total of 107 studies which described specific risk factors related to craniopharyngioma recurrence were identified which included but not limited to 54 retrospective case series, 7 systematic reviews, 21 laboratory reports, 13 case reports and 12 literature reviews. Conclusion: Based on the evidence identified in this review, the risk factors for recurrence in craniopharyngioma management are interrelated in a complex way, and surgery with or without adjuvant radiotherapy is reported to be of long-term benefit, but a disparity in findings suggests no definitive consensus on the risk factors of craniopharyngioma recurrence. More high-quality research is needed.

show abstract

Intracystic bleomycin for cystic craniopharyngiomas in children

Abstract: Editorial group: Cochrane Childhood Cancer Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 7, 2016.

Cited by 32 publications

References 41 publications

The Diagnosis and Treatment of Craniopharyngioma

The Diagnosis and Treatment of Craniopharyngioma

Suprasellar and recurrent pediatric craniopharyngiomas: expanding indications for the extended endoscopic transsphenoidal approach

Clinical, Pathological and Surgical Risk Factors Associated with Craniopharyngioma Recurrence: A Literature Review

Contact Info

Product

Resources

About