Intrinsic third ventricular craniopharyngiomas: report on six cases and a review of the literature

Behari, Sanjay; Banerji, Deepu; Mishra, Ajay Kumar; Sharma, Sunil; Sharma, Sidhiraj; Chhabra, D. K.; Jain, Vibha

doi:10.1016/s0090-3019(03)00132-0

Cited by 58 publications

(66 citation statements)

References 26 publications

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“…However, several studies have shown the predominance of intraventricular lesions in older patients. 4,29,44,45 These findings have been replicated in this study and are in accordance with the purely suprasellar subpial ventricular growth pattern in our classification scheme.…”

Section: Differences In Growth Patterns Between Juvenile and Adult Casessupporting

confidence: 90%

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Pan¹,

Qi²,

Liu³

et al. 2016

PED

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OBJECT Craniopharyngiomas (CPs) are rare epithelial tumors that are often associated with an enigmatic and unpredictable growth pattern. Understanding the growth patterns of these tumors has a direct impact on surgical planning and may enhance the safety of radical tumor removal. The aim of this study was to analyze the growth patterns and surgical treatment of CPs with a focus on the involvement of the hypothalamopituitary axis and the relationship of the tumor to the arachnoid membrane and surrounding structures. METHODS Clinical data from 226 consecutive patients with primary CP were retrospectively reviewed. Tumor location and the relationship of the tumor to the third ventricle floor and the pituitary stalk were evaluated using preoperative MRI and intraoperative findings. A topographic classification scheme was proposed based on the site of tumor origin and tumor development. The clinical relevance of this classification on patient presentation and outcomes was also analyzed. RESULTS The growth of CPs can be broadly divided into 3 groups based on the site of tumor origin and on tumor-meningeal relationships: Group I, infrasellar/infradiaphragmatic CPs (Id-CPs), which mainly occurred in children; Group II, suprasellar subarachnoid extraventricular CPs (Sa-CPs), which were mainly observed in adults and rarely occurred in children; and Group III, suprasellar subpial ventricular CPs (Sp-CPs), which commonly occurred in both adults and children. Tumors in each group may develop complex growth patterns during vertical expansion along the pituitary stalk. Tumor growth patterns were closely related to both clinical presentation and outcomes. Patients with Sp-CPs had more prevalent weight gain than patients with Id-CPs or Sa-CPs; the rates of significant weight gain were 41.7% for children and 16.7% for adults with Sp-CPs, 2.2% and 7.1% for those with Id-CPs, and 12.5% and 2.6% for those with Sa-CPs (p < 0.001). Moreover, patients with Sp-CPs had increased hypothalamic dysfunction after radical removal; 39% of patients with Sp-CPs, 14.5% with Id-CPs, and 17.4% with Sa-CPs had high-grade hypothalamic dysfunction in the first 2 postoperative years (p < 0.001). CONCLUSIONS The classification of CPs based on growth pattern may elucidate the best course of treatment for this formidable tumor. More tailored, individualized surgical strategies based on tumor growth patterns are mandatory to provide long-term tumor control and to minimize damage to hypothalamic structures. Differences in the distribution of growth patterns between children and adults imply that hierarchical comparison is necessary when investigating outcomes and survival across treatment paradigms in patients with CP.

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Section: Differences In Growth Patterns Between Juvenile and Adult Casessupporting

confidence: 90%

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Pan¹,

Qi²,

Liu³

et al. 2016

PED

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“…The craniopharyngioma tends to insinuate itself into the nearby spaces and cisterns. 1,4,5,10,23 Furthermore, extension into the nasopharynx and purely intraventricular lesions have been reported. 4,31 These arachnoid planes are less appreciated in the pediatric population, recurrent cases, and cases with previous irradiation.…”

Section: Surgical Techniquementioning

confidence: 99%

“…1,4,5,10,23 Furthermore, extension into the nasopharynx and purely intraventricular lesions have been reported. 4,31 These arachnoid planes are less appreciated in the pediatric population, recurrent cases, and cases with previous irradiation. 22,26,32 In the following section, the surgical removal of the extensive craniopharyngioma via a small frontolateral craniotomy is described.…”

Section: Surgical Techniquementioning

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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“…[2] Intraventricular cystic lesions have been described in the literature, as a finding more commonly observed in older population. [6] The patients present at the Emergency Department (ED) with a variety of symptoms including headache, aphasia, lethargy, meningismus, fever, rhinorrhea as well as loss of vision acuity. [1278] In addition, cyst rupture has been correlated to cerebral vasospasm and ischemia.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous intraventricular rupture of a craniopharyngioma cyst: A case report

Vakharia

Siasios

Dorsch

et al. 2017

Int J Crit Illn Inj Sci

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Intraventricular rupture of craniopharyngioma cysts is an unusual event which is associated with a high risk of loculated or communicating hydrocephalus. A 75-year-old woman presented at the Emergency Department of our hospital with mental status deterioration due to chemical ventriculitis and acute hydrocephalus following the intraventricular rupture of a craniopharyngioma cyst. The patient was treated with stress-dose steroid therapy. In addition, she underwent placement of an external ventricular drain and endoscopy-assisted intra-cystic placement of an Ommaya reservoir for the aspiration of the cystic fluid. The patient's condition improved; she was shunted in an expeditious fashion and discharged from the Intensive Care Unit within 2 weeks of her admission with the reservoir in place for the continued drainage of the cyst.

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Intrinsic third ventricular craniopharyngiomas: report on six cases and a review of the literature

Cited by 58 publications

References 26 publications

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

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

Spontaneous intraventricular rupture of a craniopharyngioma cyst: A case report

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