Craniopharyngiomas Primarily Involving the Hypothalamus: A Model of Neurosurgical Lesions to Elucidate the Neurobiological Basis of Psychiatric Disorders

Pascual, José M.; Prieto, Ruth; Castro-Dufourny, Inés; Mongardi, Lorenzo; Rosdolsky, María; Strauss, Sewan; Carrasco, Rodrigo; Barrios, Laura

doi:10.1016/j.wneu.2018.09.053

Cited by 36 publications

(30 citation statements)

References 95 publications

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“…However, in the memory investigation, the mammillary bodies always affected due to the injury extent in the unilateral and bilateral HI pattern. Our results showed that both the unilateral-HI and bilateral-HI groups were worse than the no-HI and mild-HI groups, which is similar with the results from Pasucal et al 54 that severe memory deficits occurred with damage of the mammillary bodies. Nevertheless, the functional impairment following disturbance of hypothalamic tracts is also an important topic in exploring the hypothalamic injury, and further work is required to investigate the connecting tract between different brain regions and changes in functional parameters with DTI and fMRI studies.…”

Section: Hypothalamic Nucleus In Cp Invasionsupporting

confidence: 92%

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

et al. 2020

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The precise understanding of hypothalamic injury (HI) patterns and their relationship with different craniopharyngioma (CP) classifications remains poorly addressed. Here, four HI patterns after CP resection based on endoscopic observation were introduced. A total of 131 CP cases treated with endoscopic endonasal approach (EEA) were reviewed retrospectively and divided into four HI patterns: no‐HI, mild‐HI, unilateral‐HI and bilateral‐HI, according to intraoperative findings. The outcomes were evaluated and compared between groups in terms of weight gain, endocrine status, electrolyte disturbance and neuropsychological function before and after surgery. A systematic correlation was found between CP origin and subsequent HI patterns. The majority of intrasellar and suprasellar stalk origins lead to a no‐HI pattern, the central‐type CP mainly develops a mild or bilateral HI pattern, and the majority of tumors with hypothalamic stalk origins result in unilateral HI and sometimes bilateral HI patterns. The proportion of tumors with a maximum diameter >3 cm in the no‐HI group was higher than that in the mild‐HI group, BMI and quality of life in the no‐HI group showed better results than those in the other groups. The incidence of new‐onset diabetes insipidus in the bilateral‐HI group was significantly higher than that in the other groups. Memory difficulty was observed mainly in the unilateral‐HI and bilateral‐HI groups. However, the outcomes of electrolyte disturbance, sleep, and cognitive disorder in the unilateral‐HI group were significantly better than those in the bilateral‐HI group. This study suggests the possibility of using pre‐ and intraoperative observation of CP origin to predict four HI patterns and even subsequent outcomes after tumor removal.

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Section: Hypothalamic Nucleus In Cp Invasionsupporting

confidence: 92%

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

et al. 2020

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“…Behavioural disturbances, previously reported in other studies of CP patients, 19,28 mainly concerned a loss of self‐control with unexpected reactions leading to misunderstandings in their relationships. Alterations in self‐perception were also noticed by women who required induction of puberty, reporting very different experiences of the process leading to developing a ‘woman's body’.…”

Section: Discussionmentioning

confidence: 81%

Women's perceptions of femininity after craniopharyngioma: a qualitative study

Eydoux

Castinetti

Authier

et al. 2020

Clinical Endocrinology

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Background Previous quantitative studies have shown a reduced quality of life in patients treated for craniopharyngioma (CP). However, few have assessed their sexual quality of life and other issues related to patient intimacy have not yet been addressed. Standardized questionnaires limit the approach to sexuality and the exploration of patient experiences. A qualitative study, which allows in‐depth analysis, may represent an interesting approach to explore intimacy in women with a history of CP. Objective To assess the impact of a CP history on femininity and relationships in women. Design and patients A qualitative study with semi‐structured interviews was conducted with 15 adult women treated for CP during childhood, adolescence or at childbearing age up to 40 years of age. Interviews were audio recorded, anonymized and transcribed literally. Data analysis was carried out with an inductive approach according to the grounded theory method. Results Three main themes were identified: (a) apparent changes leading to altered self‐perception that may impact on femininity and generate lower self‐esteem; (b) managing the hidden disabilities of the disease inducing a need for permanent control; and (c) building parenthood and couple relationships: coping with sexual dysfunction and infertility. Conclusions Our study highlighted alterations in self‐perception and femininity due to body change and disability resulting from CP treatment, impacting both couple and social relationships. Interviewing women who underwent CP surgery at different ages highlighted specific needs and different expectations of medical professionals which emphasize the importance of offering both global and personalized care.

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“…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. In our series, we observed memory disturbances, in 6/25 (24%) patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Introduction: Craniopharyngiomas constitute 2–4% of intracranial neoplasms. Intraventricular craniopharyngiomas (IVCrs) are the rarely encountered varieties of these lesions.Objective: The objective of the study was to study the special features in clinical presentation, imaging, management, and surgical outcome of IVCrs.Materials and Methods: This retrospective analysis included the combined experience from two tertiary care institutions. Medical records of histopathologically proven cases of IVCrs from January 1994 to June 2021 were assessed, and images were analyzed based on the criteria by Migliore et al. for inclusion of solely intraventricular lesion with the third ventricular ependyma demarcating it from the suprasellar cistern.Results: Among the 25 patients included (mean age: 35.4 years), the most common presentation included headache (n = 21, 84%), vomiting and other features of raised ICP (n = 18, 72%), visual complaints (n = 12, 48%), and endocrinopathies (n = 11, 44%). Fifteen had predominantly cystic tumors, two were purely solid, and eight were of mixed consistency. Primary open microsurgical procedures were performed in 18 (72%) patients, of which four (16%) were endoscope-assisted. Seven (28%) underwent a purely endoscopic procedure. One underwent a staged surgery with endoscopic cyst fenestration and intracystic interferon (IFN)-alpha therapy, followed by microsurgical excision. Complete excision was achieved in 10 patients, near-total in nine, and partial excision in six. Four patients underwent a ventriculoperitoneal shunt (one before the definitive procedure). At a median follow-up of 36 months (range:11–147 months), five patients developed a recurrence, and one had a stable small residue. This patient and two others with small cystic recurrences were observed. One patient was managed with radiotherapy alone. Another underwent re-surgery after a trial of radiotherapy, and the last patient developed a local recurrence, which was managed with radiotherapy; he then later developed an intraparenchymal recurrence, which was operated.Conclusion: Purely IVCrs present with raised intracranial pressure, and visual disturbances are less common. Their deep-seated location and limited surgical field-of-view makes minimally invasive endoscopic-assisted surgery most suitable for their excision. The thin-walled cystic lesions may be occasionally adherent to the ependymal wall in close vicinity to the thalamus–hypothalamus complex, making complete excision difficult. Their responsiveness to radiotherapy, often leads to a gratifying long-term outcome.

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Craniopharyngiomas Primarily Involving the Hypothalamus: A Model of Neurosurgical Lesions to Elucidate the Neurobiological Basis of Psychiatric Disorders

Cited by 36 publications

References 95 publications

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

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

Women's perceptions of femininity after craniopharyngioma: a qualitative study

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

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