Treatment ofCraniopharyngiomas: The Multimodality Approach

Backlund, Erik‐Olof

doi:10.1159/000120867

Cited by 60 publications

(26 citation statements)

References 11 publications

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“…Several therapies have been proposed for patients with CPs, which allows the surgeon to choose the best way to treat each individual patient. 2 The best treatment for this type of tumor is complete removal with preservation of all endocrine and visual functions, which is achieved in a small number of cases.…”

Section: Discussionmentioning

confidence: 99%

Craniopharyngiomas: intratumoral chemotherapy with interferon-α: a multicenter preliminary study with 60 cases

Cavalheiro¹,

Rocco

Valenzuela³

et al. 2010

FOC

113

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Object The authors assessed the efficacy of intratumoral interferon-α (IFNα)–based chemotherapy in pediatric patients with cystic craniopharyngiomas. Methods In a prospective multicenter study of 60 pediatric patients, the authors assessed the efficacy of intratumoral INFα2A-based chemotherapy. The study was conducted between 2000 and 2009 at 3 locations: the Medical School of the Federal University of São Paulo, Catholic University of Rome, and the Neurosurgery Institute of Santiago, Chile. The assessment included clinical and radiological control examinations, side effects observed, and total dose used. Results Sixty cases of cystic craniopharyngioma were analyzed. The cohort consisted of 35 male and 25 female children (mean age 11 years). Clinical and radiological improvement was achieved in 76% of the cases. New endocrinological deficits were observed in 13% of the cases. In approximately 30% of the patients, the evolution included some light side effects, the most common being headache (33%) and eyelid edema (28%). The number of cycles varied from 1 to 9 (mean 5 cycles), and the total dose applied per cycle was 36,000,000 IU. Conclusions This has been the largest documented series of intratumoral chemotherapy using INFα for the control of cystic craniopharyngiomas. The treatment has proved efficacious; there was no mortality, and morbidity rates were low.

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Section: Discussionmentioning

confidence: 99%

Craniopharyngiomas: intratumoral chemotherapy with interferon-α: a multicenter preliminary study with 60 cases

Cavalheiro¹,

Rocco

Valenzuela³

et al. 2010

FOC

113

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“…Several authors have reported high recurrence rates despite apparently complete tumor resection and negative postoperative brain imaging, providing another strong argument for the concept of limited surgery combined with other therapeutic approaches, such as radiotherapy or intracystic catheter placement. 2,3,30,37,42,43,50,62,68,71,78,83,84,89,92,98 The surgical routes used to remove craniopharyngiomas have previously been transcranial approaches, whereas the transsphenoidal approach, in accordance with the indications defined by Guiot and Derome 35 in the early 1960s, was proposed initially for infradiaphragmatic lesions, with an enlarged sella, preferably in patients who had already developed panhypopituitarism. 72 More recently, technological progress and advances in terms of visualization permitted the extension of the microscopic transsphenoidal approach to a variety of suprasellar lesions.…”

mentioning

confidence: 99%

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Cavallo

Günther

Cappabianca

et al. 2014

JNS

202

198

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Object Despite their benign histological appearance, craniopharyngiomas can be considered a challenge for the neurosurgeon and a possible source of poor prognosis for the patient. With the widespread use of the endoscope in endonasal surgery, this route has been proposed over the past decade as an alternative technique for the removal of craniopharyngiomas. Methods The authors retrospectively analyzed data from a series of 103 patients who underwent the endoscopic endonasal approach at two institutions (Division of Neurosurgery of the Università degli Studi di Napoli Federico II, Naples, Italy, and Division of Neurosurgery of the Bellaria Hospital, Bologna, Italy), between January 1997 and December 2012, for the removal of infra- and/or supradiaphragmatic craniopharyngiomas. Twenty-nine patients (28.2%) had previously been surgically treated. Results The authors achieved overall gross-total removal in 68.9% of the cases: 78.9% in purely infradiaphragmatic lesions and 66.3% in lesions involving the supradiaphragmatic space. Among lesions previously treated surgically, the gross-total removal rate was 62.1%. The overall improvement rate in visual disturbances was 74.7%, whereas worsening occurred in 2.5%. No new postoperative defect was noted. Worsening of the anterior pituitary function was reported in 46.2% of patients overall, and there were 38 new cases (48.1% of 79) of postoperative diabetes insipidus. The most common complication was postoperative CSF leakage; the overall rate was 14.6%, and it diminished to 4% in the last 25 procedures, thanks to improvement in reconstruction techniques. The mortality rate was 1.9%, with a mean follow-up duration of 48 months (range 3–246 months). Conclusions The endoscopic endonasal approach has become a valid surgical technique for the management of craniopharyngiomas. It provides an excellent corridor to infra- and supradiaphragmatic midline craniopharyngiomas, including the management of lesions extending into the third ventricle chamber. Even though indications for this approach are rigorously lesion based, the data in this study confirm its effectiveness in a large patient series.

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“…Essa substância é um antibiótico que atua em carcinomas de células escamosas, interferindo na replicação do DNA tumoral, levando à diminuição da produção de liquor e degeneração celular (32,34).…”

Section: Outras Opções Injeção Intratumoral De Bleomicinaunclassified

“…O efeito sobre a massa tumoral é principalmente sobre a parte cística, tendo pouco efeito sobre a parte sólida do tumor (34).…”

Section: Outras Opções Injeção Intratumoral De Bleomicinaunclassified

Atualização terapêutica no tratamento dos craniofaringiomas

Bordallo

Ferreira

Bulzico

2011

Arq Bras Endocrinol Metab

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O craniofaringioma é uma neoplasia de natureza benigna, pouco frequente, responsável por 1% a 3% de todos os tumores intracranianos, sendo a mais frequente neoplasia intracraniana não neuroepitelial na criança. Geralmente o tumor é restrito à região selar e ao III ventrículo, mas, em decorrência da infiltração e frequente aderência ao sistema nervoso central, apresenta comportamento clínico muitas vezes desfavorável, sendo classificado pela Organização Mundial de Saúde (OMS) como grau I, caracterizado como tumor de baixo ou incerto potencial de malignização. As sequelas endocrinológicas ganham destaque devido ao importante impacto na qualidade de vida dos pacientes, na maioria das vezes crianças. O hipopituitarismo e a obesidade hipotalâmica são complicações frequentes, sendo o tratamento desse tumor um grande desafio para endocrinologistas e neurocirurgiões. A combinação da cirurgia, radioterapia e aplicação de drogas e radioisótopos intratumorais tem como objetivo maximizar as chances de cura e tentar minimizar as sequelas pós-operatórias, mas, mesmo assim, a recidiva ainda é frequente. A escolha da modalidade de tratamento mais adequado para os craniofaringiomas é uma decisão difícil e que deve sempre ser individualizada para cada paciente. Com o objetivo de explorar as múltiplas opções terapêuticas para o craniofaringioma, foi realizada revisão na literatura com ênfase nas possibilidades terapêuticas e complicações inerentes ao tratamento dessa patologia.

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Treatment ofCraniopharyngiomas: The Multimodality Approach

Cited by 60 publications

References 11 publications

Craniopharyngiomas: intratumoral chemotherapy with interferon-α: a multicenter preliminary study with 60 cases

Craniopharyngiomas: intratumoral chemotherapy with interferon-α: a multicenter preliminary study with 60 cases

The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Atualização terapêutica no tratamento dos craniofaringiomas

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