Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma

Laville, Adrien; Capel, Cyrille; Maroote, J.; Lefranc, Michel

doi:10.1016/j.ctro.2020.05.003

Cited by 5 publications

(7 citation statements)

References 27 publications

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“…To overcome this recurrent complication, a catheter or, more preferably, ORS insertion is recommended. 18,[25][26][27] Chemotherapy had no role in our study. In Mansour et al 20 and Rachinger et al, 28 chemotherapy also had no role.…”

Section: Discussionmentioning

confidence: 88%

Surgical results of using the Ommaya reservoir system for the management of cystic craniopharyngiomas: A retrospective single‐centre experience

Mohamed

Shalaby

2023

Surgical Practice

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Background: The management options for cystic craniopharyngioma (CP) are controversial. Surgical resection (gross or partial), radiotherapy, chemotherapy, cyst aspiration, and Ommaya reservoir system (ORS) implantations are the options for management that are used individually or in combination, but the ideal treatment is unclear.Objective: We aimed to investigate the functional outcomes and the complications of Ommaya reservoir system (ORS) insertion as a treatment option for cystic CP.Methods: Between January 2018 and January 2020, 12 patients with enhanced cystic CP were treated by cyst fenestration and aspiration on the day of surgery, and an ORS was inserted. The period between the procedure time and the last outpatient visit was considered the follow-up period. Results:The main presenting symptoms were increased intracranial pressure, visual defects, and hormonal changes. The clinical symptoms improved, and the tumour cysts appeared to stabilize after catheter placement without the need for repeated aspirations; of the 12 patients included, only one case needed re-aspiration. The eight patients who had signs of increased intracranial pressure reported resolved symptoms (100%). Of the 12 patients, seven and six patients showed improved visual acuity and improved visual field defect. Conclusion:Cyst fenestration and insertion of ORS is a safe and effective treatment option for cystic CP. ORS can be used in de novo cases as a treatment option alone without further invasive treatment to alleviate symptoms and improve clinical status, especially the visual changes.

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Section: Discussionmentioning

confidence: 88%

Surgical results of using the Ommaya reservoir system for the management of cystic craniopharyngiomas: A retrospective single‐centre experience

Mohamed

Shalaby

2023

Surgical Practice

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“…[9] An analysis of adult patients with cystic craniopharyngiomas concluded that the use of the Ommaya reservoir with SRT could minimize radiation exposure to the optic apparatus and brain stem. [8,12,15] In this study, only one tumor was identified to have enlarged and categorized as TP, which was mainly a cystic lesion. We selected FSRT because the tumor compressed the optic nerve.…”

Section: Discussionmentioning

confidence: 95%

“…The previous studies have indicated tumor enlargement during or after the treatment, especially in craniopharyngiomas with cystic components. [ 1 , 8 , 12 ] A group of pediatric patients with this tumor received proton beam therapy and intensity-modulated RT after RT. In 52 patients, 40% had cyst growth during RT and 20% required intervention such as cyst decompression or adaptive replanning.…”

Section: Discussionmentioning

confidence: 99%

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Effects of two different radiotherapies for craniopharyngiomas using stereotactic radiosurgery/ stereotactic radiotherapy or fractionated stereotactic radiotherapy

Kamogawa¹,

Shuto²,

Matsunaga³

2022

Surgical Neurology International

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Background: Numerous studies have reported about good tumor control with both stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for residual and recurrent craniopharyngiomas, but no studies have reported on the appropriate use of different types of radiation modalities. This study aimed to report the outcomes of SRS/stereotactic radiotherapy (SRT) or FSRT and compare tumor control in a single center. Methods: From 2014 when TrueBeamTM STx with Novalis was introduced in our hospital to 2021, 21 patients underwent SRS/SRT or FSRT with gamma knife surgery (GKS) and Novalis. We have selected the radiation modalities considering mainly the distance of the optic nerve and chiasm. Imaging and clinical follow-up data were sent and reviewed. Results: The mean age was 52 years and there were 11 men. Of the 21 total patients, three experienced SRS (GKS, 50% isodose 12–15 Gy), five underwent SRT (GKS or Novalis, 19.5–24 Gy 3 fractions), and 13 patients underwent FSRT (Novalis, 54 Gy 30 fractions). The median follow-up was 32.6 (range 17–44) months after SRS/SRT and 34.0 (range 4–61) months after FSRT. In the SRS/SRT group, the mean tumor volume decreased from 1.103 to 0.131 cm3 (P < 0.01), and in the FSRT group, from 3.015 to 1.012 cm3 (P < 0.01). No radiation-induced optic neuropathy and other acute toxicity occurred. Conclusion: Craniopharyngioma can be expected to have very good tumor control by selecting SRS/SRT or FSRT depending on the distance between the optic nerve and the tumor.

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“…The addition of adjuvant radiotherapy may facilitate local tumor control after Ommaya catheter placement for cystic craniopharyngiomas [73][74][75][76]. A recent case series of six patients by Laville et al found favorable local tumor control at 12-month follow-up after combined Ommaya reservoir placement and hypofractionated radiotherapy at lower doses of radiation than would be required had the cyst not been drained [77]. Likewise, Jarebi et al also described a patient in whom stereotactic Ommaya reservoir placement and adjuvant radiosurgery of the solid component of a cystic craniopharyngioma successfully alleviated visual deficits and intracranial hypertension without the need for open surgery [71].…”

Section: Stereotactic Cyst Decompressionmentioning

confidence: 99%

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

Hong

Omay

2022

Current Oncology

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Craniopharyngiomas are rare, benign primary brain tumors that arise from remnants of the craniopharyngeal duct epithelium within the sellar and suprasellar region. Despite their benign biology, they may cause significant morbidity, secondary to involvement of nearby eloquent neural structures, such as the pituitary gland, hypothalamus, and optic apparatus. Historically, aggressive surgical resection was the treatment goal to minimize risk of tumor recurrence via open transcranial midline, anterolateral, and lateral approaches, but could lead to clinical sequela of visual, endocrine, and hypothalamic dysfunction. However, recent advances in the endoscopic endonasal approach over the last decade have mostly supplanted transcranial surgery as the optimal surgical approach for these tumors. With viable options for adjuvant radiation therapy, targeted medical treatment, and alternative minimally invasive surgical approaches, the management paradigm for craniopharyngiomas has shifted from aggressive open resection to more minimally invasive but maximally safe resection, emphasizing quality of life issues, particularly in regards to visual, endocrine, and hypothalamic function. This review provides an update on current multi-modal approaches for craniopharyngiomas, highlighting the modern surgical treatment paradigm for this disease entity.

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Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma

Cited by 5 publications

References 27 publications

Surgical results of using the Ommaya reservoir system for the management of cystic craniopharyngiomas: A retrospective single‐centre experience

Surgical results of using the Ommaya reservoir system for the management of cystic craniopharyngiomas: A retrospective single‐centre experience

Effects of two different radiotherapies for craniopharyngiomas using stereotactic radiosurgery/ stereotactic radiotherapy or fractionated stereotactic radiotherapy

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

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