Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement

Puget, Stéphanie; Garnett, Matthew; Wray, Alison; Grill, Jacques; Habrand, Jean‐Louis; Bodaert, Nathalie; Zérah, Michel; Bezerra, M. Rebello; Rénier, Dominique; Pierre-Kahn, Alain; Sainte‐Rose, Christian

doi:10.3171/ped.2007.106.1.3

Cited by 267 publications

(316 citation statements)

References 44 publications

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“…Because craniopharyngioma is a rare disease, children and adolescents with craniopharyngioma should be documented uniformly in prospective studies. There are current prospective studies in process on a national and multinational level to adopt strategies tailored to risk factors for morbidity and QoL (1,2,13,(16)(17)(18). We conclude that radical excision surgery is not an appropriate treatment strategy in patients with childhood craniopharyngioma and hypothalamic involvement, especially in cases with involvement of posterior hypothalamic areas (II8).…”

Section: Middle Vs Smallmentioning

confidence: 96%

“…One of the biggest challenges in treating craniopharyngioma is identifying the best candidates for the radical versus the conservative approach. Experiential expertise in large centres (defined as the number of operations per year) in western countries has increased the possibility of safe gross total resection, evidenced by two reports representing historically different attitudes: the first at Necker Hospital (13), which is more surgically oriented, and the second in North America (16), which is more oriented towards a conservative approach. The North American experience shows that most recent cases now receive moderate or aggressive surgery and only 42% have limited surgery before irradiation.…”

Section: Middle Vs Smallmentioning

confidence: 99%

“…The North American experience shows that most recent cases now receive moderate or aggressive surgery and only 42% have limited surgery before irradiation. The Necker study authors (13) show in a contemporary study that 96% of their recent cases achieve complete (23%) or subtotal resection (73%) and that radiotherapy is performed in 50% of cases after subtotal resection. It appears that there is a trend towards radiotherapy in centres with past prevalent surgical approaches and towards continuation of surgical treatment in centres historically conservative oriented.…”

Section: Middle Vs Smallmentioning

confidence: 99%

“…Although there have been relatively few opportunities for systematic study of hypothalamic lesions in man (9,10), there is controversy over whether and to what extent hypothalamic involvement is the apriori risk factor for adverse late effects (11), or whether obesity following surgery is more related to neurosurgical hypothalamic injury (9,10,(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

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Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Müller

Gebhardt²,

Teske³

et al. 2011

European Journal of Endocrinology

228

235

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Background: Hypothalamic obesity has major impact on prognosis and quality of life (QoL) in childhood craniopharyngioma. Patients and methods: For this study, 120 patients were prospectively recruited during 2001 and 2007 and evaluated after 3 years of follow-up (KRANIOPHARYNGEOM 2000). Body mass index (BMI) and QoL at diagnosis and 36 months after diagnosis were analysed based on the reference assessment of tumour localisation and post-surgical hypothalamic lesions. Treatment was analysed based on the neurosurgical strategy of 50 participating neurosurgical centres, the centre size based on the patient load. Results: BMI SDS at diagnosis was similar in patients with or without hypothalamic involvement. Surgical lesions of anterior and posterior hypothalamic areas were associated with higher increase in BMI SDS during 36 months post-diagnosis compared with patients without or only anterior lesion (C1.8 BMISD, PZ0.033, C2.1 BMISD; PZ0.011), negative impact on QoL in patients with posterior hypothalamic lesions. Surgical strategies varied among the 50 neurosurgical centres (three largesized, 24 middle-sized and 23 small-sized centres). Patients treated in small-sized centres presented with a higher rate of hypothalamic involvement compared with those treated in the middle-and largesized centres. Treatment in large-sized centres was less radical, and the rates of complete resection and hypothalamic surgical lesions were lower in large-sized centres than those of the middle-and smallsized centres. However, a multivariable analysis showed that pre-operative hypothalamic involvement was the only independent risk factor for severe obesity (PZ0.002). Conclusions: Radical neurosurgical strategies leading to posterior hypothalamic lesions are not recommended due to the potential to exacerbate hypothalamic obesity and impaired QoL. Treatment should be confined to experienced multidisciplinary teams.

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Section: Middle Vs Smallmentioning

confidence: 96%

Section: Middle Vs Smallmentioning

confidence: 99%

Section: Middle Vs Smallmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Müller

Gebhardt²,

Teske³

et al. 2011

European Journal of Endocrinology

228

235

View full text Add to dashboard Cite

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“…HI of CP has been reported as a major risk factor to impairment of long-term survival (7,8,14) and quality of life (8,21,22,23,24,25,26,27,28,29,30) in CP patients. The question of whether DOH before diagnosisspecifically whether prolonged interval between the first appearance of symptoms and the time of diagnosiscontributes to adverse sequelae and impaired survival had not been answered before this study.…”

Section: Discussionmentioning

confidence: 99%

History before diagnosis in childhood craniopharyngioma: associations with initial presentation and long-term prognosis

Hoffmann

Boekhoff

Gebhardt

et al. 2015

European Journal of Endocrinology

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Objective: Childhood craniopharyngiomas (CP) are often diagnosed after a long duration of history (DOH). Tumor size, hypothalamic involvement (HI), and obesity are associated with reduced overall survival (OS) and functional capacity (FC). The effect of DOH and specific symptoms in history on presentation at initial diagnosis and long-term prognosis are unknown. Design: Retrospective analysis of patients' records and prospective longitudinal follow-up. Methods: Histories of 411 CP patients recruited in HIT Endo, KRANIOPHARYNGEOM 2000 were retrospectively evaluated for DOH, symptoms, and characteristics. The effect of specific manifestations and DOH on clinical presentation and tumor characteristics at time of initial CP diagnosis and long-term outcome were analyzed. Main outcome measures were 10-year OS and progression-free survival (PFS), FC, and BMI during longitudinal follow-up. Results: Median DOH was 6 months (range: 0.1-108 months) and correlated with age at diagnosis. Tumor size, HI, degree of resection, and BMI at diagnosis were not related to DOH. In multivariate analysis adjusted for age at diagnosis, only hydrocephalus was found to have a relevant influence on DOH. Visual and neurological deficits were associated with larger initial tumor size and impaired 10-year OS. Weight gain and growth failure were observed with longest DOH. PFS and FC were not related to any specific symptom. Endocrine deficits at diagnosis were associated with long DOH. Conclusions: CP is frequently diagnosed after long DOH, especially in older children. However, DOH was not associated with tumor size, HI, survival, or FC. Visual and neurological deficits necessitate rapid diagnostic workup.

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Intracystic bleomycin for cystic craniopharyngiomas in children

Yuan

Cai

et al. 2016

Cochrane Database of Systematic Reviews

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Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement

Cited by 267 publications

References 44 publications

Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up

History before diagnosis in childhood craniopharyngioma: associations with initial presentation and long-term prognosis

Intracystic bleomycin for cystic craniopharyngiomas in children

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