Craniopharyngiomas of the Third Ventricle: Trans-Lamina Terminalis Approach

Maira, Giulio; Anile, Carmelo; Colosimo, Cesare; Cabezas, Daniel

doi:10.1097/00006123-200010000-00014

Cited by 122 publications

(65 citation statements)

References 24 publications

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“…For this reason, we have compared the data from the subgroup of cases that we treated in the period between 1990 and 2016 (MRI-era subcohort, n = 225) with the cases reported in large surgical CP series in the literature of the last 2 decades. 6,10,11,14,21,22,24,27,46,48,52,[55][56][57]59 The perioperative death rate in our MRIera subcohort was 5%, an almost identical rate compared with the reported rate in recent surgical series. 34 Poor postoperative outcome due to hypothalamic injury occurred in 15% of patients of the MRI-era subcohort, a figure very close to that reported among large surgical series (from 5% to 20% depending on the series).…”

Section: Adherence Of Cps: a Factor Determining The Surgical Risk Of supporting

confidence: 77%

Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors

Prieto

Pascual

Rosdolsky³

et al. 2016

FOC

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OBJECTIVE Craniopharyngioma (CP) adherence strongly influences the potential for achieving a radical and safe surgical treatment. However, this factor remains poorly addressed in the scientific literature. This study provides a rational, comprehensive description of CP adherence that can be used for the prediction of surgical risks associated with the removal of these challenging lesions. METHODS This study retrospectively analyzes the evidence provided in pathological, neuroradiological, and surgical CP reports concerning 3 components of the CP attachment: 1) the intracranial structures attached to the tumor; 2) the morphology of the adhesion; and 3) the adhesion strength. From a total of 1781 CP reports published between 1857 and 2016, a collection of 500 CPs providing the best information about the type of CP attachment were investigated. This cohort includes autopsy studies (n = 254); surgical studies with a detailed description or pictorial evidence of CP adherence (n = 298); and surgical CP videos (n = 61) showing the technical steps for releasing the attachment. A predictive model of CP adherence in hierarchical severity levels correlated with surgical outcomes was generated by multivariate analysis. RESULTS The anatomical location of the CP attachment occurred predominantly at the third ventricle floor (TVF) (54%, n = 268), third ventricle walls (23%, n = 114), and pituitary stalk (19%, n = 94). The optic chiasm was involved in 56% (n = 281). Six morphological patterns of CP attachment were identified: 1) fibrovascular pedicle (5.4%); 2) sessile or patch-like (21%); 3) cap-like (over the CP top, 14%); 4) bowl-like (around the CP bottom, 13.5%); 5) ring-like (encircling central band, 19%); and 6) circumferential (enveloping the entire CP, 27%). Adhesion strength was classified in 4 grades: 1) loose (easily dissectible, 8%); 2) tight (requires sharp dissection, 32%); 3) fusion (no clear cleavage plane, 40%); and 4) replacement (loss of brain tissue integrity, 20%). The types of CP attachment associated with the worst surgical outcomes are the ring-like, bowl-like, and circumferential ones with fusion to the TVF or replacement of this structure (p < 0.001). The CP topography is the variable that best predicts the type of CP attachment (p < 0.001). Ring-like and circumferential attachments were observed for CPs invading the TVF (secondary intraventricular CPs) and CPs developing within the TVF itself (infundibulo-tuberal CPs). Brain invasion and peritumoral gliosis occurred predominantly in the ring-like and circumferential adherence patterns (p < 0.001). A multivariate model including the variables CP topography, tumor consistency, and the presence of hydrocephalus, infundibulo-tuberal syndrome, and/or hypothalamic dysfunction accurately predicts the severity of CP attachment in 87% of cases. CONCLUSIONS A comprehensive descriptive model of CP adherence in 5 hierarchical levels of increased severity—mild, moderate, serious, severe, and critical—was generated. This model, based on the location, morphology, and strength of the attachment can be used to anticipate the surgical risk of hypothalamic injury and to plan the degree of removal accordingly.

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Section: Adherence Of Cps: a Factor Determining The Surgical Risk Of supporting

confidence: 77%

Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors

Prieto

Pascual

Rosdolsky³

et al. 2016

FOC

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“…17 The commonly described approaches include pterional, unilateral, or bilateral frontal interhemispheric approaches. 8,33,34,37 Other approaches include the transcallosal or translamina terminalis approaches for intraventricular craniopharyngiomas, 25,37 and the orbitozygomatic approach, 13 endoscopic transsphenoidal approaches, and the petrosal approach for retrochiasmatic craniopharyngiomas. 1,2,6,[10][11][12]16 Accessibility of the Tumor…”

Section: Discussionmentioning

confidence: 99%

“…14,20,27,29,30 However, the long-term consequences of these methods as primary treatment are unclear, and they are not without complications. 1,11,12,15,17,21,[24][25][26] …”

Section: Approach-related Complicationsmentioning

confidence: 99%

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Gerganov¹,

Metwali²,

Samii³

et al. 2014

JNS

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Object. An extensive craniopharyngioma is a tumor that extends into multiple compartments (subarachnoid spaces) and attains a size larger than 4 cm. A wide spectrum of approaches and strategies has been used for resection of such craniopharyngiomas. In this report the authors focused on the feasibility and efficacy of microsurgical resection of extensive craniopharyngiomas using a frontolateral approach.Methods. A retrospective analysis was performed on 16 patients with extensive craniopharyngiomas who underwent operations using a frontolateral approach at one institution. The preoperative and postoperative clinical and radiological data, as well as the operative videos, were reviewed. The main focus of the review was the extent of radical tumor removal, early postoperative outcome, and approach-related complications.Results. Gross-total resection of craniopharyngioma was achieved in 14 (87.5%) of 16 cases. Early after surgery (within 3 months), 1 patient showed improvement in hormonal status, while in the remaining 15 patients it worsened. No major neurological morbidity was observed. Two patients experienced temporary psychotic disorders. Visual function improved in 6 patients and remained unchanged in 9. One patient experienced a new bitemporal hemianopsia. Three patients with features of short-term memory disturbances at presentation did show improvement after surgery. There were no deaths or significant approach-related morbidity in this patient series. Only 1 patient required revision surgery for a CSF leak.Conclusions. The safe and simple frontolateral approach provides adequate access even to extensive craniopharyngiomas and enables their complete removal with a reasonable morbidity and approach-related complication rate. (http://thejns.org/doi/abs/10.3171/2013.9.JNS122133) Key worDs • extensive craniopharyngioma • frontolateral • giant craniopharyngioma • microsurgery • outcome • oncology • skull base 559Abbreviations used in this paper: ACA = anterior cerebral artery; ACoA = anterior communicating artery; CPA = cerebellopontine an gle; GTR = gross-total resection; ICA = internal carotid artery; PCoA = posterior communicating artery. * Drs. Fahlbusch and M. Samii share senior authorship of this work.

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“…However, the surgical outcomes for large craniopharyngiomas remain controversial. 1,6,10,11,[15][16][17]19,[22][23][24][27][28][29]31,[34][35][36][37][38][39][40][41][42]44,45) Furthermore, most reports on craniopharyngioma have focused primarily on children 10,[15][16][17]22,27,41,42) or mixed series, 1,19,23,24,31,34,36,[38][39][40]45) and studies of only adults are limited. 6) The postoperative endocrinological state of patients treated for craniopharyngioma is critical to the quality of life.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Diabetes Insipidus After Pituitary Stalk Sectioning During Surgery for Large Craniopharyngioma-Endocrinological Evaluation and Clinical Implications for Surgical Strategy-

Nishizawa

Ohta

Osuga

2006

Neurol. Med. Chir.(Tokyo)

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The mechanism of spontaneous resolution of diabetes insipidus (DI) was investigated after surgery for large craniopharyngioma. Twenty-two adult patients (mean age 48.9 years old), who underwent surgery via the anterior interhemispheric trans-lamina terminalis approach, were divided into three groups: Group I, the entire pituitary stalk was preserved (n ＝ 2); Group II, the stalk was dissected distally from the tumor but ultimately sacrificed (n ＝ 9); Group III, the stalk was not identified and was sacrificed (n ＝ 11). All patients were discharged without neurological deficits 1 month after surgery. Four patients underwent gamma-knife treatment for residual tumor or recurrence. Postoperative endocrinological functions were normal in Group I, and no replacement therapy was required. Hormonal replacement for pan-hypopituitarism and DI was necessary in Groups II and III (mean follow-up period 5.9 years). DI resolved at 2.7 ± 1.3 years after surgery in four patients in Group II, and a hypertonic saline infusion test revealed production of small amounts of intrinsic antidiuretic hormone (ADH). Urine osmolarity was high in the morning, and a significant increase in urinary osmolarity was noted after Pitressin injection. These results indicate induction of hypersensitivity of the distal renal tubules to small amounts of intrinsic ADH, resulting in decreased urinary output. Recovery from DI can be expected, despite permanent impairment of anterior pituitary function, if the pituitary stalk is dissected as distally as possible.

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Craniopharyngiomas of the Third Ventricle: Trans-Lamina Terminalis Approach

Cited by 122 publications

References 24 publications

Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors

Craniopharyngioma adherence: a comprehensive topographical categorization and outcome-related risk stratification model based on the methodical examination of 500 tumors

Microsurgical resection of extensive craniopharyngiomas using a frontolateral approach: operative technique and outcome

Spontaneous Resolution of Diabetes Insipidus After Pituitary Stalk Sectioning During Surgery for Large Craniopharyngioma-Endocrinological Evaluation and Clinical Implications for Surgical Strategy-

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