Understanding treatment options in craniopharyngioma better

Qi, Songtao

doi:10.1038/s41572-020-0173-1

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…On the whole, on the premise of minimizing hypothalamic damage, reasonable management and control of cyst wall and stem cells may be the most active treatment. Although treatment strategies for craniopharyngiomas are controversial, researchers all understand the limitations of current treatment and are optimistic about the prospect of molecular biology research 5 , 37 , 51 , 52 . Therefore, based on the existence of stem cells, if the cyst wall is left after surgery, we should actively seek more effective treatment methods, including radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Molecular biological features of cyst wall of adamantinomatous craniopharyngioma

Chuan

Wang²,

Liu

et al. 2023

Sci Rep

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The molecular biological differences between cyst walls and those in solid bodies are the foundation of the outcomes. In this study, the CTNNB1 mutations were confirmed by DNAsequencing; CTNNB1 expression levels were detected by PCR; the differences between solid bodies and cyst walls in proliferative capacity and tumor stem cell niches were assessed by immunohistochemistry; the effect of the residual cyst wall on recurrence was assessed by follow-up. Mutations in the CTNNB1 in the cyst wall and the solid body were identical in each case. No differences were found in the transcriptional level of CTNNB1 between the cyst walls and the solid bodies (P = 0.7619). The cyst wall showed a pathological structure similar to the solid body. Proliferative capacity of cyst walls was stronger than that of solid body (P = 0.0021), and β-catenin nuclear positive cells (cell clusters) in cyst walls were more than that in solid tumor (P = 0.0002). The retrospective 45 ACPs showed residual cyst wall was significantly associated with tumor recurrence or regrowth (P = 0.0176). Kaplan–Meier analysis showed there was a significant difference in the prognosis between GTR and STR (P < 0.0001).The cyst wall of ACP contained more tumor stem cell niches which could lead to the recurrence. According to the above-mentioned, a special attention to the management of the cyst wall should be paid.

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Section: Discussionmentioning

confidence: 99%

Molecular biological features of cyst wall of adamantinomatous craniopharyngioma

Chuan

Wang²,

Liu

et al. 2023

Sci Rep

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“…During the operation, the tumor must be separated from the pituitary stalk along the direction of the pituitary stem. If the pituitary stalk is in the center of the tumor, it must be incised to free the tumor and then try to protect the remaining pituitary stalk ( 36 , 38 , 39 ). For T-type craniopharyngiomas originating from the pars tuberalis, there is only a layer of pial mater between the tumor and the hypothalamus, which may adhere to the nerve tissue in the later stage and is not easy to be separated by surgery, and thus requires to find the boundary between the tumor and the normal tissue ( 35 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…If the pituitary stalk is in the center of the tumor, it must be incised to free the tumor and then try to protect the remaining pituitary stalk ( 36 , 38 , 39 ). For T-type craniopharyngiomas originating from the pars tuberalis, there is only a layer of pial mater between the tumor and the hypothalamus, which may adhere to the nerve tissue in the later stage and is not easy to be separated by surgery, and thus requires to find the boundary between the tumor and the normal tissue ( 35 , 39 ). For the latter two types, partial tumors of the pituitary stalk cannot be preserved and could be dissected early to reduce the difficulty of tumor resection ( 35 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

Xie

et al. 2022

Front. Neurol.

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ObjectiveTo explore the surgical approach and technique of neuroendoscopic endonasal resection of pediatric craniopharyngiomas and to further evaluate its safety and effect in children.MethodsThe clinical data of 8 children with craniopharyngiomas who were surgically treated by neuroendoscopy through an extended endonasal approach in our center from 2018 to 2021 were retrospectively analyzed. The related surgical approach and technique were evaluated to improve the surgical results and further reduce the surgical complications when removing craniopharyngioma in children.ResultsAll 8 patients achieved a gross-total resection of the tumor under neuroendoscopy. Postoperatively, 2 cases of transient hyperthermia and 4 cases of transient hyper- and/or hyponatremia occurred within the first 2 weeks, all of which were quickly controlled. Seven patients had symptoms of diabetes insipidus to varying degrees after the operation, and 4 of them improved within 1–3 months after surgery, but 3 cases still needed oral pituitrin. There were no cases of coma or death, leakage of cerebrospinal fluid, or severe electrolyte imbalance after surgery. During the postoperative follow-up of 3 months to 2 years, no tumor recurrence was found. Among the 7 patients who suffered postoperative neuroendocrine deficiencies, 3 patients were found to be temporary during the follow-up, but 4 patients still required hormone replacement therapy. Particularly, postoperative visual deterioration and olfactory defect that occurred in patients were all improved during follow-up periods. In addition, 4 cases of obesity were noted at the last follow-up.ConclusionsExtended neuroendoscopic endonasal resection of craniopharyngiomas may be used as a safe and effective approach for children. Due to the poor pneumatization of the sphenoid sinus and worse compliance of treatment in children, surgical techniques of exposing the sellar region, removing the tumor, and reconstructing the skull base, as well as postoperative management of patients was proposed. However, due to the limited surgical cases in the study, the surgical safety and effects of the extended neuroendoscopic endonasal approach for children with craniopharyngiomas need to be further studied in the future.

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“…Based on an improved understanding of the tumor, we could gain useful information for approach selection, surgical planning, or the prediction of hypothalamic-pituitary outcomes on the basis of surgical approach. [14][15][16][17] However, it should be also noted that the incidence of CP is relatively low compared with other intracranial tumors, which means the study samples are small in most neurosurgical institutions, and therefore thoughtful studies regarding the tumor remain sparse. Future studies including innovative molecular imaging techniques may improve our understanding of tumor origin and the relationship between the tumor and hypothalamic-pituitary axis, and thereby better inform preoperative surgical approach or planning by tumor classification.…”

mentioning

confidence: 99%

Editorial. Craniopharyngioma classification

Magill

Jane

Prevedello

2021

Journal of Neurosurgery

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raniopharyngiomas (CPs) are among the most surgically complex brain tumors due to their deep location and intimate involvement with critical neural and vascular structures. Furthermore, injury to the adjacent hypothalamus, infundibulum, pituitary gland, optic apparatus, or vasculature can have devastating consequences including hypothalamic obesity, autonomic dysregulation, panhypopituitarism, blindness, and major strokes. Their location, arising from the sella up through the third ventricle, can be accessed via multiple surgical approaches. Broadly, the approaches include variants of the transcallosal, transsylvian, subfrontal, and endonasal approach, all of which are viable options for CP resection. Determining the ideal approach has been a source of lively debate among neurosurgeons for many years, and as such, several classification systems based on surgeon experience have been proposed, including the classification by Fan et al. in the current issue. 1 The ideal classification system is one that would predict functional outcomes, extent of resection, and recurrence rates, based on tumor characteristics, patient anatomy, and approach. This would allow the neurosurgeon to select the approach that would provide the best outcome for each patient's unique tumor. The first classification was put forward in 1990 by Gazi Yaşargil based on his microsurgical experience with 144 CPs (Table 1). 2 His classification system was based on the relationship of the tumor with the surrounding anatomical structures, foremost of which were the diaphragma sellae, the tuber cinereum/floor of the third ventricle, and the third ventricle/hypothalamus. The primary challenge during this era was in preoperative diagnostic imaging to understand relationships of the tumor with these structures, because MRI was a relatively new technology at the time. Nevertheless, this anatomical relationship was key to guiding the surgical approach. The pterional approach was used most frequently by Yasargil because it allowed early identification of the stalk, anterior circulation, and protection of the optic chiasm. When tumors extended superiorly in the third ventricle, he would combine the pterional with a transcallosal approach. He

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Understanding treatment options in craniopharyngioma better

Cited by 4 publications

References 9 publications

Molecular biological features of cyst wall of adamantinomatous craniopharyngioma

Molecular biological features of cyst wall of adamantinomatous craniopharyngioma

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

Editorial. Craniopharyngioma classification

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