Pathological Relationship Between Adamantinomatous Craniopharyngioma and Adjacent Structures Based on QST Classification

Abstract

The aim of this study was to clarify pathological and anatomical relationships between adamantinomatous craniopharyngiomas (ACP) and their surrounding structures. We previously established a QST classification scheme based on the apparent anatomic origin of the tumors. According to this classification, 13 type Q tumors, 6 type S tumors, and 42 type T ACPs were analyzed. Type Q tumors, which are most likely to involve the pituitary gland, did not invade the area of contact with the adenohypophysis. Instead, tumor invasion was observed in areas where the tumor contacted the neurohypophysis. Type S tumors primarily involved the pituitary stalk; the arachnoid remained present between these tumors and normal structures. Type T tumors were located beneath the basal arachnoid membrane and outside the pia mater. The pia mater was disrupted and finger-like invasions were found in the neural layer of the third ventricle floor along the invasive front. Tumors were never observed to break through the ependymal layer of the third ventricle. The QST classification has important implications for understanding the growth pattern of tumors and can be used to guide surgical procedures.

Biological Behaviour of Craniopharyngiomas

“…In this minireview, we will discuss the main features that differentiate ACP and PCP, and elaborate how the biological differences have helped identify novel targeted treatments. Further readings are recommended to cover more detailed pathological and clinical descriptions [4-11].…”

Clinical impact of craniopharyngioma classification based on location origin: a multicenter retrospective study

“…Although CPs are benign tumors, they are likely to involve the hypothalamic-pituitary axis and surrounding structures, which may limit surgical options to partial resection or lead to severe postoperative complications after total resection, especially severe hypothalamic reactions. To ensure safe surgical resection and avoid severe hypothalamic injury, understanding the pattern of gliosis is essential (2)(3)(4)11). The classification based on the origin of the tumor details the relationship of the surrounding structures to CPs and purports to predict and identify the intraoperative anatomical stratification.…”

“…The pituitary stalk (PS) was divided into four segments in accordance with the folds of the arachnoid sleeve around the pituitary stalk (ASPS) (11). Accordingly, we categorized the tumors into three types (3,5). The origin site of type Q CP is located below the diaphragmatic area and the extra-arachnoidal, intra-arachnoidal, and subarachnoidal segments of the PS as situated above the tumor.…”

“…Surgical resection is the treatment of choice for CP, and the extent of resection plays a major role in the outcome of surgery. Performing complete resection at presentation offers an optimal choice for tumor control and potential cure with an acceptable morbidity rate (2)(3)(4). Hence, a suitable surgical approach can improve survival.…”

Understanding treatment options in craniopharyngioma better

“…Three patterns regarding the relationship between tumour and the third ventricular floor were identified based on our research: mantle like, moat like and mortise like. To ensure safe surgical resection and avoid severe hypothalamic injury 3 , under standing the pattern of gliosis is essential. Müller et al 1 proposed preoperative grading of the hypothalamic involvement using pre operative images, which can mistakenly reflect the interplane of tumour to nervous tissue.…”