Microsurgery for Giant Craniopharyngiomas in Children

Al‐Mefty, Ossama; Hassounah, Maher; Weaver, Philip; Sakati, Nadia; Jinkins, J. R.; Fox, John L.

doi:10.1227/00006123-198510000-00009

Cited by 56 publications

(32 citation statements)

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“…1,3,8,9,37 Not only is the size of the tumor gaining attention, but also its extension into multiple compartments (subarachnoid spaces). Thus, we advocate using the term "extensive craniopharyngioma" for a craniopharyngioma that extends into many compartments other than the chiasmatic cistern and attains a size larger than 4 cm.…”

Section: ©Aans 2014mentioning

confidence: 99%

“…37 Al-Mefty et al reported a 90% rate of giant craniopharyngioma resection in those operations he personally performed using a sophisticated petrosal approach, and a 30% resection rate in a series of patients previously operated on by other surgeons. 3 Gardner et al reported complete resection in 8 of 11 patients in whom total resection was planned, in a total series of 16 patients with variable tumor sizes and extensions. 11 …”

Section: Extent Of Tumor Resectionmentioning

confidence: 99%

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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: ©Aans 2014mentioning

confidence: 99%

Section: Extent Of Tumor Resectionmentioning

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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“…They are the most common non-glial tumors in childhood 2 and originate from the embryonic remains of squamous cells through the hypophyseal-pharyngeal duct.…”

Section: Introductionmentioning

confidence: 99%

“…There are frequent fluctuations in sodium level in the postoperative period such that patients at times exhibit diabetes insipidus and at other times inappropriate secretion of antidiuretic hormone, progressing with either hypernatremia or hyponatremia that is difficult to control and may lead to severe brain damage or even death. Patients may also exhibit hyperphagia, obesity, low stature and psychiatric disorders in the later postoperative period 1,2,4 . There is no consensus in the literature on the best way to treat an adamantinomatous craniopharyngioma in childhood.…”

Section: Introductionmentioning

confidence: 99%

Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon

Dastoli

Nicácio

Silva

et al. 2011

Arq. Neuro-Psiquiatr.

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Objective: To assess whether the cystic craniopharyngiomas can be controlled with the use of intratumoral applications of interferon alpha. Method: Nineteen patients with the diagnosis of cystic craniopharyngioma were treated with intratumoral chemotherapy with interferon alpha from January 2002 to April 2006. All patients underwent placement of an intracystic catheter connected to an Ommaya reservoir. Through this reservoir were made applications during chemotherapy cycles. Each cycle corresponded to application of 3,000,000 units of interferon alpha three times per week on alternate days totalizing 36,000,000 units. Response to treatment was evaluated by calculating the tumor volume on MRI control after one, three and six months after the end of each cycle. Patients who developed worsening of symptoms or who had insignificant reduction in tumor volume during follow-up underwent repeat cycle chemotherapy. Results: Four patients received four cycles of chemotherapy, three patients received three cycles, six patients received two cycles and six patients received one. The lower percentage of reduction in tumor volume was 60% and the bigger reduction was 98.37%. Eleven patients had a reduction greater than 90%. Five patients had a tumor reduction between 75 and 90% and in three patients the tumors were reduced by less than 75%. No deaths occurred during treatment and side effects of interferon alpha were well tolerated. No treatment was discontinued. Follow-up after the last application ranged from one year and five months to three years and nine months. Conclusion: The intratumoral chemotherapy with interferon alpha decreases the volume of cystic craniopharyngiomas and so far can be considered a new therapeutic alternative.

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“…19 Other authors report increased mortality, 94 increased neurological and hypothalamic morbidity, 14,22,94 decreased extent of resection and local disease control, 14,16,23,27,28,39,46,68,74,86,91 and higher rates of tumor recurrence 14,22,29,34,83,91 in larger tumors. Some authors, however, report tumor size or volume to have no impact on extent of resection, 2,4,50,88,95 rate of recurrence 49,63 or hypothalamic morbidity. 63 Various treatment strategies have been proposed to combat these difficult tumors, including cyst aspiration, 30,78 intracavitary irradiation 33,61,89 or chemotherapy, 32,37,82 radical resection, 2,95 or limited resection plus RT for tumors of all sizes.…”

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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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Microsurgery for Giant Craniopharyngiomas in Children

Cited by 56 publications

References 0 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

Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon

Surgical management of giant pediatric craniopharyngiomas

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