Endocrine and neurologic outcome in childhood craniopharyngioma: Review of effect of treatment in 42 patients

Thomsett, M. J.; Conte, Felix A.; Kaplan, Selna L.; Grumbach, M.M.

doi:10.1016/s0022-3476(80)80254-x

Cited by 219 publications

(104 citation statements)

References 44 publications

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“…42,53 Authors have reported GTR rates ranging from 5 to 90%. 3,5,7,9,14,20,26,37,40,42,47,[51][52][53]56 Yaşargil et al 56 was able to achieve a 90% GTR rate, but reported a 9.0% rate of intraoperative and early postoperative mortality and a 16.7% overall mortality rate. Given the morbidity and mortality associated with GTRs, some investigators have advocated STR combined with postoperative radiation as an alternative when the risk of a GTR would likely be associated with formidable morbidity.…”

Section: Discussionmentioning

confidence: 97%

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Campbell¹,

McGettigan

Luginbuhl

et al. 2010

FOC

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Object The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. Methods Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. Results Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. Conclusions The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

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Section: Discussionmentioning

confidence: 97%

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Campbell¹,

McGettigan

Luginbuhl

et al. 2010

FOC

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“…At the University of California, San Francisco, patients who un derwent biopsy sampling or cyst resection and radiation had 100% disease control, whereas in more than half of the children undergoing subtotal resection and radiation, the treatment failed. 19,36,44 Similarly, children treated with conservative surgery and radiation in Boston experienced 95-100% disease control, whereas patients treated with subtotal resection and radiation only achieved 67-83% disease control.…”

Section: 33mentioning

confidence: 99%

Radiation therapy for pediatric craniopharyngioma

Kiehna

Merchant

2010

FOC

118

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Object The treatment of craniopharyngioma is highly controversial. Continued advances in limited surgery and radiation therapy have maintained excellent local disease control while minimizing treatment-related sequelae. Further analyses of outcomes are necessary to characterize the long-term effects of radiation therapy. Methods An extensive literature review was performed for all studies including radiation therapy, with or without surgery, for pediatric craniopharyngioma. Results The authors identified 32 papers describing radiation therapy for treatment of pediatric craniopharyngioma, with disease control ranging from 44 to 100%. Modern studies report at least 90% disease control with 5-year follow-up. Fifteen studies reported outcomes, demonstrating that more than two-thirds of patients treated with surgery and radiation therapy have favorable outcomes, and this rate is more than 85% in the modern era. Conclusions Conservative surgery and radiation therapy results in long-term disease control in pediatric patients with craniopharyngioma that is comparable to results obtained with radical surgery alone. However, children with craniopharyngioma remain vulnerable to late treatment failures and side effects from radiation therapy, including endocrinopathies, vasculopathies, and secondary tumors, which may be detrimental to the quality of life. Long-term follow-up beyond 5–10 years is necessary to assess tumor control relative to functional outcomes.

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“…Morbidity associated with treatment is dependent on the size, location, and invasiveness of the tumor, the experience of the surgeon and the route of surgical approach. Craniopharyngiomas are generally radiosensitive and stereotactic radiosurgery has been used with success; since up to 60% of craniopharyngiomas are both solid and cystic, adjuvant treatments such as cyst aspiration or stereotactic Ommaya reservoir (for intracavity brachitherapy with bleomycin, radioactive phosphorus, or alpha-emitting 90Yt) are used to avoid surgery in situations where the solid part of the tumor is small or surgery is not possible or not indicated in younger patients [11][12][13][14][15][16].…”

Section: Craniopharyngiomasmentioning

confidence: 99%

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

Keil

Stratakis

2008

Expert Review of Neurotherapeutics

123

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Pituitary tumors are rare in childhood and adolescence, with a reported prevalence of up to 1 per million children. Only 2 -6% of surgically treated pituitary tumors occur in children. Although pituitary tumors in children are almost never malignant and hormonal secretion is rare, these tumors may result in significant morbidity. Tumors within the pituitary fossa are of two types mainly, craniopharyngiomas and adenomas; craniopharyngiomas cause symptoms by compressing normal pituitary, causing hormonal deficiencies and producing mass effects on surrounding tissues and the brain; adenomas produce a variety of hormonal conditions such as hyperprolactinemia, Cushing disease and acromegaly or gigantism. Little is known about the genetic causes of sporadic lesions, which comprise the majority of pituitary tumors, but in children, more frequently than in adults, pituitary tumors may be a manifestation of genetic conditions such as multiple endocrine neoplasia type 1 (MEN 1), Carney complex, familial isolated pituitary adenoma (FIPA), and McCune-Albright syndrome. The study of pituitary tumorigenesis in the context of these genetic syndromes has advanced our knowledge of the molecular basis of pituitary tumors and may lead to new therapeutic developments.

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Endocrine and neurologic outcome in childhood craniopharyngioma: Review of effect of treatment in 42 patients

Cited by 219 publications

References 44 publications

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Radiation therapy for pediatric craniopharyngioma

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

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