Clinical impact of craniopharyngioma classification based on location origin: a multicenter retrospective study

Abstract

Background: An assessment of the clinical impact for craniopharyngiomas (CPs) classification based on origin location has not been reported. The aim of this study was to determine the clinical impact of the site of tumor origin in primary CPs.Methods: Patients from six national institutions who had undergone resection for primary CP were enrolled. Based on the point of origin and surrounding membranous structures, the location of the tumor origin was labelled as Q, S, or T, where Type Q CPs originated below the diaphragmatic area; Type S CPs originated from Rathke's pouch precursor cells; and Type T CPs originated from the Rathke's pouch precursor cells located above the pars tuberalis. Clinical characteristics, surgical approach, and outcome were evaluated according to the location of the tumor origin.Results: Among the 529 patients with primary CP, symptoms, age, histopathology type, tumor size, the incidence of hydrocephalus, survival rates, and recurrence-free survival rates were significantly different among tumors originating in different locations. Patients with type T CPs had higher symptom rates of intracranial hypertension and hypothalamic dysfunction, while those with type Q CPs had higher rates of hormone deficits during pre-and post-operative management. Type S CPs were correlated with better outcomes and lower recurrence rates. The location of origin and primary therapy with survival and recurrence in CP were independent factors for survival and recurrence in multivariate analysis. Conclusions:The identification of the different location of origin of CPs is of great significance in understanding the relationship between tumors and peripheral tissues. The origin of tumors effects the choice of surgical approach and prognosis.

Clinical Features of Craniopharyngioma With Tumoral Hemorrhage: A Retrospective Case-Controlled Study

“…This may represent a state of pituitary or hypothalamic disorder and necessitate continuous monitoring as well as individualized electrolyte supplementation. Apart from CP apoplexy, the origin location or the extend of compression on the infundibulum can also affect the incidence rates of these complications ( 27 , 28 ). We further investigated the patients and found that those who presented post-operative electrolyte disturbances, hypothalamic syndrome, or death had more severe compression on the anterior hypothalamus than those who did not (Grade 2 on the image: 11/23 vs. 60/162).…”

Craniopharyngioma surgery for rhinologists

“…Imaging also allows for anatomical classification of the tumor as entirely intrasellar, prechiasmatic, retrochiasmatic, or intraventricular [15]. More recently, the QST system has been used to classify craniopharyngiomas as originating from below the diaphragmatic area, or in an infrasellar location (Q); from the precursor cells of Rathke's pouch in the middle or inferior segment of the pituitary stalk (S); and from precursor cells of Rathke's pouch that are located above the pars tuberalis, extending upward into the third ventricle (T), with studies indicating improved and outcomes in type S craniopharyngiomas [9,16]. Prefixed chiasm anatomy, in which the optic chiasm is located over the tuberculum sella, is associated with a narrower surgical corridor between the optic nerves whereas postfixed chiasm anatomy, in which the optic chiasm is located over the dorsum sella, is associated with a wider surgical corridor in this location [17].…”

Characteristics and factors influencing hypothalamic pituitary dysfunction in patients with craniopharyngioma

“…According to the 2021 World Health Organization Classification of Tumors of the Central Nervous System, there are two types of CP, adamantinomatous craniopharyngioma (ACP) and papillary craniopharyngioma (PCP), with significantly different etiologies, imaging features, histopathological characteristics, genetic changes, and methylation profiles ( 1 ). ACP is derived from the epithelial cells of the craniopharyngeal canal or residual tissues of Rathke’s pouch, while PCP originates from the residual squamous cells of the original oral fossa ( 2 ). CP accounts for approximately 2–3% of all brain tumors in adults and 6–10% in children.…”