MR of craniopharyngiomas: tumor delineation and characterization

Pusey, E; Kortman, Keith E.; Flannigan, B D; Tsuruda, Jay S.; Bradley, William G.

doi:10.2214/ajr.149.2.383

Cited by 79 publications

(48 citation statements)

References 1 publication

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“…After aspiration, 90 yttrium was implanted into the cyst. Presently, MR imaging provides more detailed information about tumor location and extent [22] and is extremely helpful in choosing the most appropriate surgical approach. Therefore, in this more recent series, total or nearly total tumor removal was intended, whereas mere transnasal cyst aspiration was performed in only one patient in poor general condition who had a suprasellar craniopharyngioma without sellar enlargement.…”

Section: Discussionmentioning

confidence: 99%

“…Since 1971 we have subtotally resected most of the latter-described tumors via a transnasal approach; the senior author has published the results over the period of 1971 to 1984. [14] Magnetic resonance (MR) imaging, which provides detailed information about tumor location and extent, [22] is extremely helpful in planning the surgical approach. Moreover, pressure-irrigation-suction systems and mirror techniques allow removal of extrasellar tumor components under visual control.…”

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confidence: 99%

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Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

Abe

Lüdecke

1997

FOC

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Results of primary transnasal surgery were evaluated in 35 patients (18 males and 17 females) with intrasellar and suprasellar craniopharyngiomas treated between 1985 and 1996 when more refined surgical and diagnostic techniques were available. Patients ranged in age from 8 to 72 years (mean 27 years); 14 patients were younger than 18 years of age. The transnasal approach was chosen because of sellar enlargement and presence of infradiaphragmatic tumor. The paramedian portion of the normal pituitary gland was incised vertically to reach a dorsally located tumor in 25 patients. Complete tumor resection was achieved in 15 patients and subtotal removal in 19; in one patient, only aspiration of cyst contents was performed. Tumor regrowth was seen in three patients after subtotal removal; in two, total tumor removal was achieved by a second transnasal surgery, whereas radiotherapy was administered in the other. In a single patient, total tumor removal was achieved by a second transcranial surgery after cyst aspiration. The duration of the clinical follow-up period was at least 1 year. Persistent diabetes insipidus appeared after total tumor resection in five patients. Cerebrospinal fluid leakage occurred in three patients, with two requiring revision. Among 29 patients with preoperatively normal pituitary functions, 20 (69%) were preserved after primary total resection, whereas six (19.4%) of 31 previously disturbed functions were normalized. After subtotal removal including cyst aspiration, 39 (88.6%) of 44 normal functions were preserved, whereas nine (24.3%) of 37 disturbed functions were normalized. The transnasal approach should be the first choice in infradiaphragmatic craniopharyngiomas with sellar enlargement in cases in which the extrasellar portion is mostly cystic and is accessible. The concept of subtotal removal with preservation of pituitary functions, especially when treating craniopharyngioma in children, seems to be justified.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

Abe

Lüdecke

1997

FOC

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“…Many adults present with a variety of anterior pituitary hormone deficiencies and 23% develop DI (Freda & Post 1999). CT is the ideal modality for the evaluation of the bony anatomy, identification of calcification and in distinguishing the solid and cystic components of the tumour (Pusey et al 1987). Pre-and post-contrast enhanced images identify the cystic lesions as a non-enhancing areas of low attenuation; the solid component and the cystic capsule appear as contrast-enhancing areas (Pusey et al 1987).…”

Section: G a Kaltsas Et Al: Parasellar Tumoursmentioning

confidence: 99%

“…CT is the ideal modality for the evaluation of the bony anatomy, identification of calcification and in distinguishing the solid and cystic components of the tumour (Pusey et al 1987). Pre-and post-contrast enhanced images identify the cystic lesions as a non-enhancing areas of low attenuation; the solid component and the cystic capsule appear as contrast-enhancing areas (Pusey et al 1987). MRI following contrast enhancement offers valuable topographic and structural analysis (Karavitaki et al 2006; Table 2).…”

Section: G a Kaltsas Et Al: Parasellar Tumoursmentioning

confidence: 99%

The diagnosis and management of parasellar tumours of the pituitary

Kaltsas

Evanson²,

Chrisoulidou³

et al. 2008

Endocrine Related Cancer

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The sellar and parasellar region is an anatomically complex area where a number of neoplastic, inflammatory, infectious, developmental and vascular diseases can develop. Although most sellar lesions are due to pituitary adenomas, a number of other pathologies involving the parasellar region can present in a similar manner. The diagnosis of such lesions involves a multidisciplinary approach, and detailed endocrinological, ophthalmological, neuroimaging, neurological and finally histological studies are required. Correct diagnosis prior to any intervention is essential as the treatment of choice will be different for each disorder, particularly in the case of primary malignant parasellar tumours. The complexity of structures that define the parasellar region can produce a variety of neoplastic processes, the malignant potential of which relies on histological grading. In the majority of parasellar tumours, a multimodal therapeutic approach is frequently necessary including surgery, radiotherapy, primary or adjuvant medical treatment and replacement of apparent endocrine deficits. Disease-specific medical therapies are mandatory in order to prevent recurrence or further tumour growth. This is particularly important as neoplastic lesions of the parasellar region tend to recur after prolonged follow-up, even when optimally treated. Apart from the type of treatment, identification of clinical and radiological features that could predict patients with different prognosis seems necessary in order to identify high-risk patients. Due to their rarity, central registration of parasellar tumours is required in order to be able to provide evidence-based diagnostic and mainly therapeutic approaches. Endocrine-Related Cancer (2008) 15 885-903

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“…5,9,36 These lesions arise from embryological squamous epithelial remnants of the craniopharyngeal duct, or Rathke pouch, which extends along an axis from the sella turcica, pituitary gland, and pituitary stalk to the hypothalamus and floor of the third ventricle. 39,45,46,58,60 Despite their benign histopathological characteristics, their clinical course is often rather malignant, and recurrence of craniopharyngiomas is one of the most common complications of treatment, occurring in 0-57% of patients following complete resection. 5,8,10,12,13,16,17,22,26,27,30,37,38,44,50,55,56,60,62,63 Although most recurrences occur locally-in or adjacent to the suprasellar cistern-ectopic recurrence of craniopharyngioma can occur in the presence or absence of suprasellar disease.…”

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confidence: 99%

Surgical treatment of ectopic recurrence of craniopharyngioma

Elliott¹,

Moshel²,

Wisoff

2009

PED

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Local recurrence following radical resection is one of the most common complications of pediatric craniopharyngioma. Only 28 cases of ectopic recurrence of craniopharyngioma have been reported in the literature, and only 13 cases occurred in patients originally treated as children. In this consecutive series of 86 children who underwent radical resection of primary and recurrent craniopharyngiomas, 4 patients (4.7%) experienced ectopic tumor recurrence, accounting for 27% of all recurrences after gross-total resection. The authors report on the successful surgical treatment of these 4 patients and the impact of ectopic craniopharyngioma recurrence on survival.

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MR of craniopharyngiomas: tumor delineation and characterization

Cited by 79 publications

References 1 publication

Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

Recent results of primary transnasal surgery for infradiaphragmatic craniopharyngioma

The diagnosis and management of parasellar tumours of the pituitary

Surgical treatment of ectopic recurrence of craniopharyngioma

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