A membranous structure separating the adenohypophysis and neurohypophysis: an anatomical study and its clinical application for craniopharyngioma

Lu, Yuntao; Qi, Songtao; Xu, Jiaming; Shi, Jin

doi:10.3171/2014.10.peds143

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…According to the QST classification of craniopharyngioma (35)(36)(37), the Q-type craniopharyngiomas originate from below the diaphragma sellae, and it is easy to separate the tumor during surgery even if it grows large and invades the hypothalamus, because of the barrier formed by the diaphragm sellae, arachnoid and pial mater between the tumor and the hypothalamus. Some cases with sellar septal tumors should be removed together with the diaphragm to avoid tumor recurrence (35,38).…”

Section: Surgical Exposure and Tumor Resectionmentioning

confidence: 99%

“…For Ttype 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). In addition, excising the tumor along the gliosis zone in the third ventricle may partly ensure that the neural tissue and the third ventricular walls are intact (5).…”

Section: Surgical Exposure and Tumor Resectionmentioning

confidence: 99%

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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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Section: Surgical Exposure and Tumor Resectionmentioning

confidence: 99%

Section: Surgical Exposure and Tumor Resectionmentioning

confidence: 99%

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

Xie

et al. 2022

Front. Neurol.

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“…The system lays emphasis on the tumor origin and its relationship with surrounding membranous (dura, diaphragma, arachnoid, and pia) and neurovascular structures. 24,25,44,45 This classification may help to improve our understanding of the morphological features and growth patterns of CPs, as well as their exact relationships with the hypothalamic-pituitary axis.…”

Section: Qst Classificationmentioning

confidence: 99%

Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients

Fan

Liu

Peng

et al. 2021

Journal of Neurosurgery

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OBJECTIVE An assessment of the transcranial approach (TCA) and the endoscopic endonasal approach (EEA) for craniopharyngiomas (CPs) according to tumor types has not been reported. The aim of this study was to evaluate both surgical approaches for different types of CPs. METHODS A retrospective review of primary resected CPs was performed. A QST classification system based on tumor origin was used to classify tumors into 3 types as follows: infrasellar/subdiaphragmatic CPs (Q-CPs), subarachnoidal CPs (S-CPs), and pars tuberalis CPs (T-CPs). Within each tumor type, patients were further arranged into two groups: those treated via the TCA and those treated via the EEA. Patient and tumor characteristics, surgical outcomes, and postoperative complications were obtained. All variables were statistically analyzed between surgical groups for each tumor type. RESULTS A total of 315 patients were included in this series, of whom 87 were identified with Q-CPs (49 treated via TCA and 38 via EEA); 56 with S-CPs (36 treated via TCA and 20 via EEA); and 172 with T-CPs (105 treated via TCA and 67 via EEA). Patient and tumor characteristics were equivalent between both surgical groups in each tumor type. The overall gross-total resection rate (90.5% TCA vs 91.2% EEA, p = 0.85) and recurrence rate (8.9% TCA vs 6.4% EEA, p = 0.35) were similar between surgical groups. The EEA group had a greater chance of visual improvement (61.6% vs 35.8%, p = 0.01) and a decreased risk of visual deterioration (1.6% vs 11.0%, p < 0.001). Of the patients with T-CPs, postoperative hypothalamic status was better in the TCA group than in the EEA group (p = 0.016). Postoperative CSF leaks and nasal complication rates occurred more frequently in the EEA group (12.0% vs 0.5%, and 9.6% vs 0.5%; both p < 0.001). For Q-CPs, EEA was associated with an increased gross-total resection rate (97.4% vs 85.7%, p = 0.017), decreased recurrence rate (2.6% vs 12.2%, p = 0.001), and lower new hypopituitarism rate (28.9% vs 57.1%, p = 0.008). The recurrence-free survival in patients with Q-CPs was also significantly different between surgical groups (log-rank test, p = 0.037). The EEA required longer surgical time for T-CPs (p = 0.01). CONCLUSIONS CPs could be effectively treated by radical surgery with favorable results. Both TCA and EEA have their advantages and limitations when used to manage different types of tumors. Individualized surgical strategies based on tumor growth patterns are mandatory to achieve optimal outcomes.

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“…1 However, patients with craniopharyngioma may suffer from severe postoperative complications following surgical resection and radiotherapy due to the involvement of hypothalamus, ventricles, the pituitary gland, and cranial nerves. 2,3 Histopathologically, craniopharyngioma consists of either squamous papillary craniopharyngioma (PCP) and adamantinomatous craniopharyngioma (ACP). Compared with PCP, ACP has a higher rate of recurrence and a lower 5-year survival rate.…”

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confidence: 99%

Machine Learning‐Based Multiparametric Magnetic Resonance Imaging Radiomic Model for Discrimination of Pathological Subtypes of Craniopharyngioma

Huang

Xiao

et al. 2021

Magnetic Resonance Imaging

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Background: Preoperative, noninvasive discrimination of the craniopharyngioma subtypes is important because it influences the treatment strategy. Purpose: To develop a radiomic model based on multiparametric magnetic resonance imaging for noninvasive discrimination of pathological subtypes of craniopharyngioma. Study Type: Retrospective. Population: A total of 164 patients from two medical centers were enrolled in this study. Patients from the first medical center were divided into a training cohort (N = 99) and an internal validation cohort (N = 33). Patients from the second medical center were used as the external independent validation cohort (N = 32). Field Strength/Sequence: Axial T 1 -weighted (T 1 -w), T 2 -weighted (T 2 -w), contrast-enhanced T 1 -weighted (CET 1 -w) on 3.0 T or 1.5 T magnetic resonance scanners. Assessment: Pathological subtypes (squamous papillary craniopharyngioma and adamantinomatous craniopharyngioma) were confirmed by surgery and hematoxylin and eosin staining. Optimal radiomic feature selection was performed by SelectKBest, the least absolute shrinkage and selection operator algorithm, and support vector machine (SVM) with a recursive feature elimination algorithm. Models based on each sequence or combinations of sequences were built using a SVM classifier and used to differentiate pathological subtypes of craniopharyngioma in the training cohort, internal validation, and external validation cohorts. Statistical Tests: The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performance of the radiomic models. Results: Seven texture features, three from T 1 -w, two from T 2 -w, and two from CET 1 -w, were selected and used to construct the radiomic model. The AUC values of the radiomic model were 0.899, 0.810, and 0.920 in the training cohort, internal and external validation cohorts, respectively. The AUC values of the clinicoradiological model were 0.677, 0.655, and 0.671 in the training cohort, internal and external validation cohorts, respectively. Data Conclusion: The model based on radiomic features from T 1 -w, T 2 -w, and CET 1 -w has a high discriminatory ability for pathological subtypes of craniopharyngioma. Level of Evidence: 4 Technical Efficacy: 2

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A membranous structure separating the adenohypophysis and neurohypophysis: an anatomical study and its clinical application for craniopharyngioma

Cited by 14 publications

References 11 publications

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children

Endoscopic endonasal versus transcranial surgery for primary resection of craniopharyngiomas based on a new QST classification system: a comparative series of 315 patients

Machine Learning‐Based Multiparametric Magnetic Resonance Imaging Radiomic Model for Discrimination of Pathological Subtypes of Craniopharyngioma

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