Craniopharyngiomas primarily affecting the hypothalamus

Intraventricular Craniopharyngiomas—Overcoming Their Relative Inaccessibility: Institutional Experience With a Review of Literature

“…Diabetes insipidus, behavioral changes, autonomic nervous system disturbances such as disturbances in sleep rhythm, appetite, body core temperature, and disturbances in memory, may also be observed (due to hypothalamic dysfunction as a result of the tumor invasion into the lateral wall or floor of the third ventricle) ( 3 , 37 – 39 ). Cognitive or psychological disturbances can be due to primary hypothalamic involvement by the tumor, ( 40 ) hydrocephalus, or forniceal involvement due to pressure.…”

Craniopharyngioma and the Third Ventricle: This Inescapable Topographical Relationship

“…In the last decade, the experience gained from using the endonasal endoscopically assisted approach (EEA) has made this technique the gold standard for treating most sellar and suprasellar CPs ( 7 , 8 ). Nevertheless, a high rate of CPs develop primarily at the infundibulo-tuberal region of the third ventricle floor (3VF) and expand within the 3V, above an intact pituitary gland and stalk ( 9 , 10 ). The pervasive problem of identifying a “safe” cleavage plane through the tenacious adherence between the CP and the adjacent hypothalamus has remained the major obstacle for radical excision of infundibulo-tuberal CPs employing the EEA ( 11 , 12 ) This difficulty becomes particularly delicate when dealing with papillary CPs (PCPs) having a strict or intrinsic 3V location, for which the EEA was originally regarded unsuitable and too risky, as it forced breaking through the seemingly functional 3VF, a maneuver that could potentially cause irreversible hypothalamic sequelae ( 13 , 14 ).…”

“…Potentially, a paradigm shift in the surgical method of choice to remove 3V CPs might occur from these studies, from the dominant use of transcranial-transventricular routes to a generalized use of the EEEA plus TLT ( 5 , 22 ). Beyond that, however, all these works can shed light on the specific pathological features and hypothalamic alterations associated with infundibulo-tuberal and strictly 3V CPs, two topographical categories which need to be differentiated from the rest of sellar/suprasellar lesions ( 10 ).…”

“…Two major CP topographies primarily originate within the neural tissue of the infundibulum and tuber cinereum, the components of the 3VF: the not strictly intraventricular or infundibulo-tuberal, which expands within the 3VF itself and replaces it progressively; and the strictly intraventricular, which, owing to its subependymal origin, mostly expands within the 3V cavity above a stretched but anatomically intact infundibulum ( 9 , 28 ) ( Figure 1 ). Both types represent lesions primarily affecting the hypothalamus, which means that the tumor is partly or wholly embedded within the 3VF, often encircled by a band of non-functional gliotic tissue ( 10 ). Infundibulo-tuberal CPs constitute approximately 40% of lesions in the adult CP population.…”

“…Strictly 3V PCPs characteristically present weaker, lower-risk attachments to the 3VF than not strictly intraventricular ACPs ( 12 , 23 ). Interestingly, despite their more benign attachment, these PCPs with an intrinsic or strict intra-3V development very often cause a wide range of psychiatric disturbances (in up to 60% of patients), owing to the severe tumoral compression upon the hypothalamus ( 10 , 29 ). These emotional, behavioral and cognitive alterations, poorly addressed in most surgical CP series, represent a true organic model of psychiatric disease of great potential relevance for elucidating the neurobiological basis of psychiatric disorders ( 29 ).…”