Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas

Sarkar, Sauradeep; Chacko, Shireen R; Korula, Sophy; Simon, Anna; Mathai, Sarah; Chacko, Geeta; Chacko, Ari G

doi:10.1007/s00701-020-04591-4

Cited by 18 publications

(4 citation statements)

References 47 publications

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“…Thus, instead of maximally radical surgery, partial or subtotal resection without hypothalamic damage was advised [1,3,5,11,14,32,62]. Similar results were observed in several retrospective series as well as in one prospective German trial and in recent study from the RT 1 protocol and confirmed that non-radical surgery with adjuvant irradiation could provide very good outcomes in terms of progression-free survival and overall survival [1,5,[30][31][32]32,33,[33][34][35][36][37][38][39][40][41][42][43][44]57,62]. Also, a recently published study from a German group (RT2CR) confirmed these results [58].…”

Section: Discussionsupporting

confidence: 69%

“…In studies with a very long observation period, similar rates of endocrine deficits were noticed [1,11,12,[48][49][50][51][52][53][54]. The worsening of already existing endocrinopathies were reported in all the studies in which radiotherapy was used, however, the rate of such complications varies between the studies-from 7% to 47% [3,9,44,45,[50][51][52][53]. When surgery is combined with radiotherapy, some complications could be observed many years after the treatment, and it is difficult to precisely define the reason for hypothalamic-pituitary axis damage.…”

Section: Discussionmentioning

confidence: 88%

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

Napieralska¹,

Mandera

Sordyl

et al. 2023

Children

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An analysis of patients below 21 years old treated due to craniopharyngioma in the years 1979–2022 was performed with the aim of evaluating the long-term outcome and treatment side-effects. The standard statistical tests were used, and 56 patients with a median age of 11 years were evaluated. Surgery was the primary treatment in 55 patients; however, in only 29 it was the only neurosurgical intervention. Eighteen children were treated with radiotherapy (RTH) in primary treatment. The most common neurosurgical side effects observed were visual and endocrine deficits and obesity, which were diagnosed in 27 (49%), 50 (91%), and 25 (52%) patients, respectively. Complications after RTH were diagnosed in 14 cases (32%). During the median follow-up of 8.4 years (range: 0.4–39.8 years), six patients died and the 5- and 10-year overall survival was 97% and 93%, respectively. Five-year progression-free survival for gross total resection, resection with adjuvant RTH, and non-radical resection alone was 83%, 68%, and 23%, respectively (p = 0.0006). Surgery combined with RTH provides comparable results to gross tumor resection in terms of oncologic outcome in craniopharyngioma patients. Adjuvant irradiation applied in primary or salvage treatment improves disease control. The rate of complications is high irrespective of improved surgical and radiotherapeutic management.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 88%

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

Napieralska¹,

Mandera

Sordyl

et al. 2023

Children

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“…The characteristics of all included studies are summarized in Table 1. 12-118 Although publication years ranged from 1990 to 2020, the study populations included those who received craniopharyngioma resections between 1960 and 2018, representing 22 countries and 12 US states. Pediatric patients (n = 2889) averaged 9.14 ± 0.14 years in age (range: 0-21 years), whereas adult patients (n = 1260) averaged 45.44 ± 1.20 (range: 18-83) years.…”

Section: Resultsmentioning

confidence: 99%

Characteristics and Outcomes in Pediatric Versus Adult Craniopharyngiomas: A Systematic Review and Meta-Analysis

et al. 2023

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BACKGROUND: Craniopharyngiomas account for 1.2% to 4.6% of all intracranial tumors. Although age at presentation is distributed bimodally, with a pediatric peak occurring between 5 and 15 years and an adult peak between 50 and 70 years, presentation, treatment, and outcome differences between these two craniopharyngioma populations have not been thoroughly characterized. OBJECTIVE: To compare treatments and outcomes between adult and pediatric craniopharyngiomas. METHODS: This is a systematic review and meta-analysis. Web of Science, MEDLINE, and Scopus databases were searched for primary studies reporting postoperative complications, functional outcomes, recurrence, and overall survival in patients with craniopharyngioma undergoing surgery. RESULTS: The search yielded 1,202 unique articles, of which 106 (n=4,202 patients) met criteria for qualitative synthesis and 23 (n=735 patients) met criteria for meta-analysis. Compared with adult, pediatric craniopharyngiomas were less likely to present with visual defects (odds ratio [OR] 0.54, 95% CI 0.36-0.80) or cognitive impairment (OR 0.29, 95% CI 0.12-0.71) and more likely with headaches (OR 2.08, 95% CI 1.16-3.73). Children presented with significantly larger tumors compared with adults (standardized mean difference 0.68, 95% CI 0.38-0.97). Comparing functional outcomes, pediatric patients sustained higher rates of permanent diabetes insipidus (OR 1.70, 95% CI 1.13-2.56), obesity (OR 3.15, 95% CI 1.19-8.31), and cranial nerve and/or neurological defects (OR 4.87,) than adults. No significant differences were found in rates of postoperative cerebrospinal fluid leak, overall or progression-free survival, or recurrence. CONCLUSION: Adult and pediatric craniopharyngiomas seem to have fundamental differences in clinical presentation and functional outcomes. These patients frequently require multimodality treatment and are best managed with a multidisciplinary team and an individualized approach.

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“…The concept of “maximum safe resection,” traditionally described in neurosurgery for the management of gliomas, has now been adopted in the management of craniopharyngiomas as well, which we know are benign tumors; especially so in children, who have a longer life expectancy and in whom the consequences of hypothalamic dysfunction (and postoperative hormonal disturbances) can significantly impair the quality of life. Most experts nowadays consider subtotal resection to be an acceptable surgical outcome (with the indispensable tool of adjuvant therapy in our armamentarium), provided that most of the tumor is removed, just short of its hypothalamic component or that which is adhered to critical neurovascular structures ( 72 ).…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

et al. 2021

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Introduction: Craniopharyngiomas constitute 2–4% of intracranial neoplasms. Intraventricular craniopharyngiomas (IVCrs) are the rarely encountered varieties of these lesions.Objective: The objective of the study was to study the special features in clinical presentation, imaging, management, and surgical outcome of IVCrs.Materials and Methods: This retrospective analysis included the combined experience from two tertiary care institutions. Medical records of histopathologically proven cases of IVCrs from January 1994 to June 2021 were assessed, and images were analyzed based on the criteria by Migliore et al. for inclusion of solely intraventricular lesion with the third ventricular ependyma demarcating it from the suprasellar cistern.Results: Among the 25 patients included (mean age: 35.4 years), the most common presentation included headache (n = 21, 84%), vomiting and other features of raised ICP (n = 18, 72%), visual complaints (n = 12, 48%), and endocrinopathies (n = 11, 44%). Fifteen had predominantly cystic tumors, two were purely solid, and eight were of mixed consistency. Primary open microsurgical procedures were performed in 18 (72%) patients, of which four (16%) were endoscope-assisted. Seven (28%) underwent a purely endoscopic procedure. One underwent a staged surgery with endoscopic cyst fenestration and intracystic interferon (IFN)-alpha therapy, followed by microsurgical excision. Complete excision was achieved in 10 patients, near-total in nine, and partial excision in six. Four patients underwent a ventriculoperitoneal shunt (one before the definitive procedure). At a median follow-up of 36 months (range:11–147 months), five patients developed a recurrence, and one had a stable small residue. This patient and two others with small cystic recurrences were observed. One patient was managed with radiotherapy alone. Another underwent re-surgery after a trial of radiotherapy, and the last patient developed a local recurrence, which was managed with radiotherapy; he then later developed an intraparenchymal recurrence, which was operated.Conclusion: Purely IVCrs present with raised intracranial pressure, and visual disturbances are less common. Their deep-seated location and limited surgical field-of-view makes minimally invasive endoscopic-assisted surgery most suitable for their excision. The thin-walled cystic lesions may be occasionally adherent to the ependymal wall in close vicinity to the thalamus–hypothalamus complex, making complete excision difficult. Their responsiveness to radiotherapy, often leads to a gratifying long-term outcome.

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Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas

Cited by 18 publications

References 47 publications

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

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

Characteristics and Outcomes in Pediatric Versus Adult Craniopharyngiomas: A Systematic Review and Meta-Analysis

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

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