Recurrent craniopharyngiomas in children and adults: long-term recurrence rate and management

Abstract

The RR was higher in children than in adults and in IECs relative to other topographic groups. Children with IECs represent a risk group. The efficacy of radiotherapy was inconclusive. Early detection of recurrences enabled safe excision with low morbidity.

Craniopharyngioma recurrence: the impact of tumor topography

“…Table 1 summarizes outcomes for the largest CP surgical series in which the results were compared between primary and recurrent cases. 3,5,7,8,[10][11][12][13]15,27,29,32 Although comparative evaluation among the cases in these series is complicated by their variable epidemiological composition and lack of validated parameters defining total removal, good outcome, and perioperative mortality, a uniform tendency toward a different outcome for primary and recurrent CPs can be recognized. The rate of radical excision falls dramatically for recurrent CPs, and operative mortality substantially increases for recurrent tumors.…”

“…12,15,29 Accordingly, the process of scarring induced by surgical maneuvers or dissection is believed to represent the explanation for the firm adherence usually found between recurrent CPs and contiguous neurovascular structures. 27,28 Undoubtedly, adhesion strength and extent of tumor play fundamental roles in the possibility of achieving safe surgical removal of recurrent CPs, yet the underlying factors for the heterogeneous types of attachment among CPs have not been properly tackled. Regrettably, a comprehensive, irrefutable analysis of the pathological characteristics accounting for the presumed disparity in adherence between primary and recurrent CPs is missing in the medical literature.…”

“…28,30,32 The group headed by Juraj Šteňo has recently indicated that the nature of tumor adhesions observed among recurrent CPs varies depending on their topography. 27 These authors found that CPs with an extraventricular location had fibrous adhesions incorporating small blood vessels between the tumor and the vascular structures of the suprasellar cistern, which were more problematic to detach than the gliotic scar between the tumor and the neural structures of the third ventricle. 27 Bao et al observed more extensive adhesions as well as a worse outcome among recurrent CPs not covered by the diaphragma sellae and in close relation with the third ventricle.…”

“…27 These authors found that CPs with an extraventricular location had fibrous adhesions incorporating small blood vessels between the tumor and the vascular structures of the suprasellar cistern, which were more problematic to detach than the gliotic scar between the tumor and the neural structures of the third ventricle. 27 Bao et al observed more extensive adhesions as well as a worse outcome among recurrent CPs not covered by the diaphragma sellae and in close relation with the third ventricle. 1 Consequently, although the resectability of recurrent CPs rests on the surgeon's subjective judgment of the feasibility of removing tenacious adherences between tumor and neighboring structures, it is the objective damage inflicted on vital brain structures that will eventually determine the surgical outcome.…”

“…Nevertheless, in previous suprasellar-pseudointraventricular tumor operations, the thin arachnoid film between the tumor and the pia mater over the tuber cinereum may have been torn off, leading to the development of tight adherences at the dome of recurrent tumors, which may add to the risk of hypothalamic injury in subsequent surgeries. 2,27 Finally, an additional topographical category of CPs involving the hypothalamus must be considered: the group of tumors originating either within the sella turcica below the diaphragma sellae or in the suprasellar compartment above the diaphragma sellae, which initially displace the TVF upward but eventually break into the hypothalamus and invade the third ventricle. This category of CPs, known in our classification scheme as secondary intraventricular CPs, may occupy 3 compartments at the time of diagnosis-the sellar area, suprasellar region, and third ventricle-presenting potentially tight adherences to each of them.…”