Clinical features and operative technique of transinfundibular craniopharyngioma

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Transinfundibular craniopharyngioma (TC) is one of the 4 subtypes of suprasellar craniopharyngioma. In this study, the authors analyzed the clinical features of and operative technique for TC.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 95 consecutive cases of suprasellar craniopharyngioma that had been resected via the endoscopic expanded endonasal approach were retrospectively reviewed. Patients were divided into 2 groups: 34 in the TC group and 61 in the nontransinfundibular craniopharyngioma (NC) group. Clinical and radiographic features, intraoperative findings, histopathological and genetic findings, and surgical outcomes were analyzed and compared between groups.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Compared with NC, TC was mostly seen in adult patients (97.1%); it was rare in children (2.9%). Clinical presentations tended toward headache, hydrocephalus, and diabetes insipidus. The relatively smaller volume, midline location (consistent with the stalk position), unidentifiable stalk, no shift of the third ventricle, and greater likelihood to involve the third ventricle and cause hydrocephalus were the characteristic features of TC in the preoperative MRI study. According to the degree of vertical extension of the tumor, the 34 TCs could be classified into 3 subtypes: type 1, entity was limited to stalk (n = 2, 5.9%); type 2, tumor extended up to the third ventricle (type 2a) or down to the subdiaphragmatic cavity (type 2b) (n = 23, 67.6%); and type 3, tumor extended in both directions (n = 9, 26.5%). For TC resection, the chiasm–pituitary corridor, lamina terminalis corridor, and pituitary corridor could be used separately or jointly. Most of the TCs originated from the infundibulum–tuber cinereum, grew within and along the long axis of the infundibulum, and the pituitary stalk was not usually preserved in TCs (20.6%), whereas the rate of preservation was higher (80.3%) in NCs. Bilateral hypothalamic injury was found in nearly all TCs if radical resection was performed, whereas the relationship between NCs and hypothalamus was either compression (32.8%) or unilateral invasion (67.2%). Meanwhile, the postoperative endocrine and neuropsychological function outcomes in patients with TC were worse than in patients with NC. The genetic analysis with whole-exome sequencing studies showed no differential mutations of <jats:italic>CTNNB1</jats:italic> (β-catenin) and <jats:italic>BRAF</jats:italic> (V600E) between TC and NC subtypes, but there was a difference between adamantinomatous craniopharyngioma and papillary craniopharyngioma.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>TC is a special subtype of suprasellar craniopharyngioma, which is remarkably different from NC. Identification of this type of tumor preoperatively is essential for the planning of appropriate surgical approach and degree of excision.</jats:p></jats:sec>

Hypothalamic injury patterns after resection of craniopharyngiomas and correlation to tumor origin: A study based on endoscopic observation

“…Since the origin of CPs could develop anywhere from the junction of the hypothalamus and the top of the parasellar region (PS) to the intrasellar segment, generally, the tumor would occur either in the form of a central-type CP or in the form of origin from one of the three areas (junction of the hypothalamus and PS, low portion of the suprasellar stalk or intrasellar stalk) we observed under EEA. To better investigate the correlation between CP origin and HI pattern, the CP origin in each patient was categorized into four types as previously described 18,20 : (a) Central-type CP: the tumor expanded within and along the stalk, had no pedicle or definite origin site could be identified; (b) Hypothalamic stalk origin: the tumor developed at the junction of the hypothalamus and PS, commonly extended up to hypothalamus and/or down to the upper PS. Sometimes invaded into the third ventricle, corresponding to the "tubero-infundibular topography" that was proposed previously 21,22 ; (c) Suprasellar stalk origin: the tumor derived from suprasellar PS segment (lower part of PS) and in general located extraventricularly; and (d) Intrasellar stalk origin: the tumor originated from the bottom part of the PS under the diaphragma.…”

Primary Infundibular Cystic and Infundibulo-Tuberal Craniopharyngioma: Report of Two Cases

“…Identification of the tumor preoperatively is important for appropriate surgical approach and degree of resection. Endoscopic endonasal transsphenoidal approach is accurate and effective with higher resection rates for infundibular craniopharyngiomas, it enables in-line access, superior visualization and observation of the relationship with vital structures such as optical chiasm, hypothalamus and pituitary stalk [8]. The adherence pattern of infundibulo-tuberal lesions and those invading the 3 rd ventricle after breaking through the infundibulum is the crucial consideration, because of adhesion into the adjacent hypothalamus, determine both the high risk of surgical hypothalamic injury if the radical resection is attempted as well as a high recurrence rate, compared to lesions only adhered to the solid pituitary stalk and outer infundibulum [15].…”

“…The patient was followed 6 months by endocrinology and neurosurgery clinics for her small solid infundibular lesion which was not considered as craniopharyngioma as the primary diagnosis, on her follow up, it was seen that the tumor was enlarged and the patient has started epithelial remnants of Rathke's pouch, originated from infundibulum-tuber cinerum and most of primary infundibular craniopharyngiomas grew along the axis of infundibulum [8]. Differential diagnoses of infundibular lesions are important for appropriate treatment.…”

“…The cyst wall was dissected from optical chiasm and the superior part of the cyst wall was removed by gentle retraction, after visualizing the anterior communicating artery complex was divided from the tumor. After resection of tumor capsule, it was dissected and removed from the pars tuberalis, the outer layer of infundibulum which is the surgical approach is very important for prevention of recurrence and loss of hypothalamic function [8,9]. With increasing experience, endoscopic endonasal approaches are more commonly used for resection of craniopharyngiomas because of its advantages.…”

Nomograms to Predict Endocrinological Deficiency in Patients With Surgically Treated Craniopharyngioma

“…Presurgical and postsurgical endocrinological status was evaluated as described previously ( 16 , 17 ). Partial hypopituitarism was defined as hormone deficiencies in one or two axes, and panhypopituitarism was defined as hormone deficiencies in three or more axes.…”