Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series

Mortini, Pietro; Losa, Marco; Pozzobon, Gabriella; Barzaghi, Lina Raffaella; Riva, Marco; Acerno, Stefania; Angius, Diana; Weber, Giovanna; Chiumello, G; Giovanelli, Massimo

doi:10.3171/2010.11.jns10670

Cited by 216 publications

(197 citation statements)

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“…23 The only study that examined the effect of surgery on QOL was by Mortini et al; however, only the Wen score was used and it was assigned retrospectively by the authors. 32 In that study, as in our study, Wen scores were shown to deteriorate. However, the accuracy of a retrospectively assigned Wen score by the treating physician may not be reliable.…”

Section: Discussionsupporting

confidence: 55%

“…9 Treatment in the form of surgery, radiation, or both, has been implicated in further deterioration. 9,24,32 In assessing a patient's response to therapy, these traditional surgical end points, however, only tell a portion of the story. In addition to survival, progression-free survival, and morbidity, a patient's QOL is becoming increasingly important in assessment of therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

“…2,10,20,22,31,41,45 As a result of these anatomical factors, aggressive resection can be associated with short-and long-term neurological sequelae and decreases in QOL. 7,9,23,32 Subtotal resection followed by radiotherapy results in a better QOL than total resection in pediatric patients, although this treatment paradigm may be associated with delayed long-term sequelae. 16 Likewise, transsphenoidal surgery has also been shown retrospectively to result in fewer acute complications.…”

mentioning

confidence: 99%

“…16 Likewise, transsphenoidal surgery has also been shown retrospectively to result in fewer acute complications. 32 In light of these issues, there is no consensus on a balanced treatment strategy considering open versus endoscopic approaches, subtotal versus aggressive resection, and the role of radiotherapy. 39 A recent survey has shown a wide diversity in treatment preferences among practicing neurosurgeons.…”

mentioning

confidence: 99%

“…The few studies on QOL that exist are generally retrospective, show a decrease in QOL compared with the normal population, and do not include a cohort having endoscopic surgery. 7,32 There is increasing evidence to support the role of endonasal endoscopic approaches in the management of selected subcohorts of patients with craniopharyngioma. 22,27 An endoscopic transsphenoidal approach offers a more direct route to the tumor, avoiding brain retraction, minimizing manipulation of the optic nerves and adjacent small perforating vessels, and resulting in equally high gross-total resection (GTR) rates compared with transcranial series, as well as potentially better visual results.…”

mentioning

confidence: 99%

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Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Patel

Raza

McCoul³

et al. 2015

JNS

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T he management of craniopharyngiomas is fraught with challenges that not only hinder achievement of optimal oncological outcomes but potentially have adverse effects on the quality of life (QOL). At time of presentation, and certainly after treatment, craniopharyngiomas can be associated with visual field defects, endocrinopathies, hypothalamic syndromes, increased cardiovascular risk, and neurocognitive sequelae. 7,9,33,37,46 Although considered benign tumors, their location can impact critical structures such as the optic nerves and chiasm, hypoabbreviatioNs ASBQ = Anterior Skull Base Quality of Life; BMI = body mass index; GTR = gross-total resection; QOL = quality of life; obJect Craniopharyngiomas are benign parasellar tumors for which surgical removal, although potentially curative, often leads to morbidity with resulting decreases in quality of life (QOL). The endonasal endoscopic approach is a minimal-access technique for removing these tumors and may reduce postoperative morbidity. The QOL following this method for resection of craniopharyngiomas has not been documented. methods The authors reviewed a database of consecutive endonasal endoscopic surgeries done at Weill Cornell Medical College. Adult patients with histologically proven craniopharyngiomas were included who had completed either only postoperative (> 9 months) or both pre- and postoperative QOL forms, the Anterior Skull Base Quality of Life (ASBQ) questionnaire, and the 22-Item Sinonasal Outcome Test (SNOT-22). Rates of gross-total resection (GTR), complications, and visual and endocrine function were collected. Retrospective independence (Wen score) was also assigned. A contemporaneous group of patients undergoing endonasal endoscopic pituitary macroadenoma resection was used as a control. results This study included 33 procedures performed in 31 patients. The average postoperative ASBQ score was 3.35 and the SNOT-22 score was 19.6. Better QOL was associated with GTR and postoperative radiation. Worse QOL was associated with persistent visual defects, hypopituitarism, tumor recurrence, increase in body mass index, and worsening Wen score. In a subset of 10 patients, both pre- and postoperative (> 9 months) QOL scores were obtained. Both ASBQ and SNOT-22 scores showed stability and a trend toward improvement, from 2.93 ± 0.51 to 2.96 ± 0.47 (ASBQ) and . Compared with 62 patients undergoing endoscopic pituitary macroadenoma resection, patients with craniopharyngiomas had worse postoperative QOL on the ASBQ (3.35 vs 3.80; p = 0.023) and p = 0.12). coNclusioNs This report of validated site-specific QOL following endoscopic surgery for craniopharyngiomas shows an overall maintenance of postoperative compared with preoperative QOL. Better QOL could be seen in patients with GTR and radiation therapy, and worse QOL was found in patients with visual or endocrine deficits. Nevertheless, patients with craniopharyngiomas still had worse QOL than those undergoing similar surgery for pituitary macroadenomas, confirming the worse prognosis of craniop...

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Section: Discussionsupporting

confidence: 55%