Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-Analysis

Dandurand, Charlotte; Sepehry, Amir Ali; Lari, Mohammad Hossein Asadi; Akagami, Ryojo; Gooderham, Peter

doi:10.1093/neuros/nyx570

Cited by 60 publications

(60 citation statements)

References 63 publications

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“…Examination of the visual function is an important element in the diagnosis, monitoring, and prognosis for craniopharyngiomas. Visual decline is one of the most freq u e n t i n i t i a l m a n i f e s t a t i o n s i n p a t i e n t s w i t h craniopharyngiomas [150], accounting for two-thirds of clinical presentation in adult-onset tumors [31]. As many as 80% of patients have a visual deficit at the preoperative ophthalmologic evaluation [159,183].…”

Section: Evidencementioning

confidence: 99%

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Cossu

Jouanneau

Cavallo³

et al. 2020

Acta Neurochir

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Background and objective Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. Material and methods The MEDLINE database was systematically reviewed (January 1970-February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. Results The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied This article is part of the Topical Collection on Pituitaries

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Section: Evidencementioning

confidence: 99%

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Cossu

Jouanneau

Cavallo³

et al. 2020

Acta Neurochir

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“…15 Post-operatively, in our patient, visual impairment decreased and hypothalamic dysfunction was not observed. In their meta-analysis, Dandurand et al 7 compared the gross total resection of CPs with subtotal resection followed by adjuvant radiotherapy and found that the lowest recurrence rate was achieved with gross total resection. In our patient, gross total resection of CP was performed, and no recurrence was observed at the first 6-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…They account for 2%-5% of intracranial tumour primers, with an incidence of 0.5-2.0 billion per year. 7 The bimodal age distribution peaks between 0 and 19 and 40 and 79 years of age. 20 While complete improvement can be achieved with radical resection of CP, high recurrence rates have been reported for partial resection.…”

Section: Introductionmentioning

confidence: 99%

Craniopharyngioma and arteriovenous malformation operated using the same craniotomy

Eren¹,

Güzey²,

Güleç³

2020

roneuro

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Craniopharyngiomas (CPs) are rare benign epithelial tumours. Brain arteriovenous malformations (AVMs) are also rare lesions occurring in young adults. The appearance of both these lesions in the same patient is rare. A 42-year-old patient presented with headaches for 3 months and a progressive decrease in his visual acuity. Bitemporal hemianopsia was detected in the visual field. Magnetic resonance imaging (MRI) revealed a tumour with cystic and solid components located in the suprasellar region and AVM in the right temporal lobe. AVM (Martin–Spetzler grade III) was visualised using digital subtract angiography (DSA), which was fed from the right middle cerebral artery and drained through the sigmoid sinus via the inferior petrosal sinus. The patient was operated with enlarged right frontotemporal craniotomy. AVM nidus was totally removed at the first operation. Embolisation was not preferred before the AVM surgery. After 3 days, sylvian dissection was performed using the same craniotomy. The tumour was completely removed via the carotid cistern by making sharp dissection from the infundibulum. Post-operatively, the patient showed normal neurological examination and significant improvement in his visual field examination. There was no residual/recurrent tumour or AVM on contrast-enhanced MRI and DSA at post-operative 6 months. Histopathological examination revealed AVM in the first operative material and papillary-type CP in the second. The coexistence of these two rare pathologies has previously been reported in only one patient. This is the first case of surgical resection of CP and AVM using the same craniotomy.

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“…Despite the tremendous progress made in diagnostic and surgical methodologies, however, the optimal treatment for these challenging lesions remains controversial. 12,17,30,32 The debate centers around what is the best surgical strategy, either radical tumor resection or limited debulking plus adjuvant therapy. 29,31,33,34 Cushing went through the same dilemma, as shown by the continuous evolution of his surgical techniques and philosophy throughout his career.…”

Section: Continuing Controversy Over Cp Treatment: Lessons Learned Frmentioning

confidence: 99%

Harvey Cushing’s craniopharyngioma treatment: Part 2. Surgical strategies and results of his pioneering series

Prieto

Pascual

Barrios

2019

Journal of Neurosurgery

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OBJECTIVEHarvey Cushing (1869–1939) developed pioneering surgical techniques for craniopharyngioma (CP) removal. This study exhaustively analyzes the pathological variables and surgical strategies that influenced Cushing’s results in his entire series of CP patients.METHODSThe CP records from Cushing’s Brain Tumor Registry were carefully reviewed, as were his CP cases published in medical monographs and scientific reports.RESULTSOne hundred twenty-four tumors with characteristics typical of CP comprise Cushing’s entire series (CP124). Cushing performed 198 surgical procedures in the patients in whom these tumors were treated, with a 23% mortality rate within the first 2 months after surgery. Three periods in Cushing’s CP surgical career can be differentiated: an early period (1901–1917, 39 patients) characterized by his use of the transsphenoidal approach and limited cyst drainage procedures, an intermediate period (1919–1925, 42 patients) in which the subfrontal approach was the standard procedure and maximal removal was attempted, and a late period (1926–1932, 43 patients) characterized by the use of air ventriculography for topographical diagnosis and limited resections via a transventricular approach. Among Cushing’s CP series were 92 cases that were pathologically verified (CP92). In this subcohort, the unilateral subfrontal approach was predominantly used (72% of cases), followed by the transsphenoidal (15%) and frontal transcortical-transventricular (8%) approaches. Drainage of the CP cystic component or partial excision of the solid component was achieved in 61% of the cases, subtotal removal in 23%, and macroscopic total removal in 10%. Satisfactory outcomes were obtained in 55% of the patients in CP92, whereas poor outcomes and/or death related to hypothalamic injury was observed in 28%. Postoperative symptoms related to hypothalamic dysfunction occurred 53% of the time. The subfrontal approach yielded the highest rates of radical removal (p < 0.001) and good outcomes (p = 0.01). Partial removals were associated with the highest rates of poor outcomes, including death (p = 0.009). Cushing’s removal of CPs with a primary infundibulo-tuberal topography or showing third ventricle invasion was associated with the highest rates of hypothalamic injury (p < 0.001) and the worst outcomes (p = 0.009).CONCLUSIONSHarvey Cushing’s techniques and surgical philosophy varied substantially throughout his career. The experience he gained with this large CP series made him aware of the importance of limiting the extent of tumor removal and leaving untouched the tumor portion strongly adhered to the hypothalamus.

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Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-Analysis

Cited by 60 publications

References 63 publications

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section

Craniopharyngioma and arteriovenous malformation operated using the same craniotomy

Harvey Cushing’s craniopharyngioma treatment: Part 2. Surgical strategies and results of his pioneering series

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