Origin of craniopharyngiomas: implication on the growth pattern

Wang, Kyu-Chang; Hong, Seok Ho; Kim, Seung-Ki; Cho, Byung-Kyu

doi:10.1007/s00381-005-1203-8

Cited by 71 publications

(46 citation statements)

References 13 publications

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“…6,27,32,33,54,55,58,62,63 These classification schemes are useful in understanding tumor topography and provide clues to aid in the selection of the optimal surgical approach for tumor removal. However, a classification system capable of describing both the details of the tumor origin and hypothalamic involvement patterns has yet to be reported in the literature.…”

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confidence: 99%

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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confidence: 99%

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Pan¹,

Qi²,

Liu³

et al. 2016

PED

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“…32 Although total resection of the tumor results in better survival benefit, craniopharyngioma surgery can be associated with a high rate of hypothalamic/hypophyseal dysfunction. The surgical procedure affects the pituitary stalk or its vasculature, resulting in postoperative endocrinological disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…Although patients with intrasellar craniopharyngiomas usually have hormonal disturbances at the time of presentation, in patients with supradiaphragmatic craniopharyngioma, the visual symptoms dominate. 1,2,4,[8][9][10][11][12][13][14][15][16][17][18]20,24,[32][33][34][35] The choice of operative approach for craniopharyngioma resection depends on the surgeon's preference and experience, considering the location and configuration of the tumor. Our current concept of management of craniopharyngiomas is gross-total resection via the frontolateral approach.…”

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confidence: 99%

Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience

Metwali¹,

Gerganov²,

Fahlbusch³

2016

JNS

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obJectiVe Preservation of the pituitary stalk and its vasculature is a key step in good postoperative endocrinological outcome in patients with craniopharyngiomas. In this article, the authors describe the surgical technique of medial optic nerve mobilization for better inspection and preservation of the pituitary stalk. Methods This operative technique has been applied in 3 patients. Following tumor exposure via a frontolateral approach, the pituitary stalk could be seen partially hidden under the optic nerve and the optic chiasm. The subchiasmatic and opticocarotid spaces were narrow, and tumor dissection from the pituitary stalk under direct vision was not possible. The optic canal was therefore unroofed, the falciform ligament was incised, and the lateral part of the tuberculum sellae was drilled medial to the optic nerve. The optic nerve could be mobilized medially to widen the opticocarotid triangle, which enhanced visualization of and access to the pituitary stalk. Results By using the optic nerve mobilization technique, the tumor could be removed completely, and the pituitary stalk and its vasculature were preserved in all patients. In 2 patients, vision improved after surgery, while in 1 patient it remained normal, as it was before surgery. The hormonal status remained normal after surgery in 2 patients. In the patient with preoperative hormonal deficiencies, improvement occurred early after surgery and hormonal levels were normal after 3 months. No approach-related complications occurred. coNclusioNs This early experience shows that this technique is safe and could be used as a complementary step during microsurgery of craniopharyngiomas. It allows for tumor dissection from the pituitary stalk under direct vision. The pituitary stalk can thus be preserved without jeopardizing the optic nerve.

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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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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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Origin of craniopharyngiomas: implication on the growth pattern

Cited by 71 publications

References 13 publications

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience

Surgical treatment of ectopic recurrence of craniopharyngioma

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