Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas

Grewal, Maeher; Spielman, Daniel; Safi, Chetan; Overdevest, Jonathan B.; Otten, Marc L.; Bruce, Jeffrey N.; Gudis, David A.

doi:10.1177/2152656720964158

Cited by 27 publications

(33 citation statements)

References 29 publications

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“…Surgical resection represents a cornerstone in the treatment of CP. Safe GTR remains the gold standard when feasible [ 25 ] and is associated with a lower risk of recurrence, described in less than 50% of patients [ 26 ]; however, it is burdened by high rates of optic and endocrinological impairment, lower QoL score [ 27 ], and a loss of full-scale intelligent quotient points compared to incomplete resection [ 7 ]. STR is associated with reduced postoperative complications, but an increased rate of recurrence has been described; progression at 5-years follow-up after incomplete resection occurs in 71–90% of patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Craniopharyngiomas in Children: A Single Center Experience

et al. 2022

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Background: Craniopharyngioma (CP) is a rare brain tumor involving the sellar region. The best management is still debated. Gross total resection (GTR) is considered the best option to improve recurrencefree survival, but considerable longterm sequelae with a significant impact on quality of life have been reported. Subtotal resection followed by radiotherapy achieves similar disease control compared to GTR with less complications. Methods: We retrospectively reviewed 10 pediatric patients affected by CP treated with partial resection and subsequent proton therapy (PBT). We reviewed visual, endocrinological, and neuropsychological data at baseline, after surgery, and after radiation for all patients. Results: At the time of diagnosis, visual impairment was detected in 70% of patients and endocrinological abnormalities in 50%. All patients were subject to one or more surgical procedures. Surgery had no impact on visual status; however, it caused a worsening of endocrine function in half of patients. After surgery, all patients underwent PBT, achieving a partial response in 7 out of 10 patients (70%), while stable disease was observed in the other three patients (30%) at a median follow-up of 78 months from the end of PBT. Both visual and endocrine deficits were stable after PBT, with neurocognitive performance scores unchanged from baseline. Conclusions: A conservative surgical approach followed by PBT represents a safe and effective strategy to manage CP and limit long-term sequelae.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Craniopharyngiomas in Children: A Single Center Experience

et al. 2022

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“…Coagulation test would be done before the surgery and we estimate blood loss to prepare for blood transfusion. Researches show that GTR indicates better prognosis with the higher survival rate and lower recurrences rate [14,15].…”

Section: Discussionmentioning

confidence: 99%

Giant pediatric intracranial tumor: Size feature and surgical strategy

Zhang¹,

Jing²,

Pang³

et al. 2021

Preprint

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Purpose: To quantify the size of the giant pediatric intracranial tumor (GPIT), analyze the character of GPIT and optimize the management of GPIT.Materials and methods: This study analyzes the clinical data of 36 cases of GPIT at a center from January 2015 to August 2020. The volume of GPITs were measured by 3D slicer software based on preoperative magnetic resonance imaging (MRI).Result: The mean volume of GPITs is 110.7ml, with the maximum volume 619.8ml and the minimum volume 27.3ml. Hemisphere held the largest mean volume of GPIT among all locations, including 7 cases whose volume is over 100ml. There is no statistical difference in volume of GPIT between sex. The most common sites of GPITs are hemisphere and cerebellum. Other locations include ventricle, sellar-parasellar region and cerebropontine angle. Medulloblastoma is the most common postoperative histopathological type, other types contain ependymoma, pilocytic astrocytoma, atypical teratoid rhabdoid tumor (AT/RT), choroid plexus carcinoma (CPC), choroid plexus papilloma（CPP）, oligodendroglioma, primitive neuroectoderm tumor (PNET), immature teratoma and yolk sac tumor. 28 cases achieved total resections while 4 cases only achieved subtotal resections. The patient with giant immature teratoma died during the operation because of bleeding. High-grade malignant tumors indicate poorer prognosis.Conclusion: GPIT is a common disease in children with unfavorable prognosis, especially in high-grade malignant tumors like CPC, PNET and AR/RT. Volume measurement based on MRI is an effective approach to access and compare the sizes of GPITs. Operation can expend the survival periods of the patients. Surgical strategies should be chosen according to the location and pathological feature of the tumors.

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“…The surgical procedure was determined by assessment of the operative report, the neurosurgeon’s and neurooncologist’s documentation and postoperative imaging, when available. Gross total resection (GTR) was defined as removal of 95% of the tumor, while the rest was considered as subtotal resection (STR) [ 12 , 13 ]. Postoperative complications were recorded and classified as systemic complication, regional complication and neurologic complications.…”

Section: Methodsmentioning

confidence: 99%

Whether surgical resection or biopsy makes difference in single lesion primary central nervous system lymphoma: a single center retrospective cohort study

et al. 2022

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Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive disease. The role of surgical resection in PCNSL has always been the center of debate. Here we investigated the clinical and follow-up data of single lesion PCNSL operated in our center, focusing on the comparison between surgical resection and biopsy. Methods All consecutive cases of single lesion PCNSL between October 2004 and December 2019 were retrospectively collected from the database of the Second Affiliated Hospital of Zhejiang University, School of Medicine. Patients were divided into resection group and biopsy group. Clinical information including age, gender, Karnofsky performance status, imaging features and postoperative treatment was collected from the medical records. All the patients were followed for survival analysis. Results A total of 105 patients with PCNSL were finally involved in our analysis. Neither PFS nor OS were significantly different between the resection group and biopsy group. The univariate analysis revealed that age < 60 and therapeutic treatment were significant predictors of longer PFS and OS. In the multivariate analysis, age (HR = 3.09, 95% CI 1.31–7.28, p = 0.01) and therapeutic treatment (HR = 0.25, 95% CI 0.07– 0.83, p = 0.02) were independent prognostic markers with OS. Multivariable Cox regression analyses also revealed that only age (HR = 2.29 (95% CI, 1.11–4.71, p = 0.03) was independent prognostic marker for PFS. Conclusions In single lesion PCNSL, there was no significant difference between the resection group and biopsy group for both PFS and OS. Younger age and postoperative treatment have been proved to be indicators of better prognosis.

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Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas

Cited by 27 publications

References 29 publications

Multidisciplinary Management of Craniopharyngiomas in Children: A Single Center Experience

Multidisciplinary Management of Craniopharyngiomas in Children: A Single Center Experience

Giant pediatric intracranial tumor: Size feature and surgical strategy

Whether surgical resection or biopsy makes difference in single lesion primary central nervous system lymphoma: a single center retrospective cohort study

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