Preoperative Assessment of Craniopharyngioma Adherence: Magnetic Resonance Imaging Findings Correlated with the Severity of Tumor Attachment to the Hypothalamus

Craniopharyngiomas: An Appropriate Surgical Treatment based on Topographical and Pathological Concepts

“…This scheme is relatively simple and has the major advantage of providing essential information about the type of hypothalamic-CP relationship that will be found during the surgical procedure. Furthermore, the relative position of the hypothalamus and its degree of anatomical distortion can be easily ascertained on preoperative MRI studies by defining the CP topography according to these categories [8,9]. In our topographical scheme, the category of sellar-suprasellar CPs is the one associating the lowest risk of hypothalamic injury, whereas the surgical risk is maximal for the secondarily-intraventricular and infundibulo-tuberal topographies that are characterized by wide and strong adhesions to the hypothalamus [7].…”

“…We were able to identify repetitive patterns of CP adhesion associated with specific tumor topographies and to present the first comprehensive classification of CP adherence [7]. Furthermore, our methodology allows for an accurate, reliable assessment of the pattern and strength of CP adhesions employing conventional MRI studies [9]. This model provides an objective way of grading the type of CP-hypothalamus adhesions into five major levels of severity, each one associating an increasing risk of hypothalamic injury during surgery.…”

“…This model provides an objective way of grading the type of CP-hypothalamus adhesions into five major levels of severity, each one associating an increasing risk of hypothalamic injury during surgery. A critical understanding of surgical risks based on the severity of CP adhesions to the hypothalamus defined on preoperative MRI may be a fundamental tool for guiding the neurosurgeons' decision regarding the safest approach to the tumor and extent of removal to be carried out in each patient [7,9].…”

“…Preoperatively recognizing the true hypothalamus position regarding the tumor, as well as the anatomical distortion of this structure, represents essential information for the neurosurgeon to anticipate the risks of hypothalamic injury and to plan accordingly the most suitable surgical procedure. Our group has recently demonstrated that an accurate definition of CP topography ( Figure 6) and the type of CP-hypothalamus adhesion ( Figure 7) can be reliably achieved with conventional MRI by examining the T1-and T2-weighted sequences [8,9]. Midsagittal and coronal-transinfundibular MRI sections are the two most important ones for a proper assessment, as CPs originate along the midline structures that form the pituitary-hypothalamic axis.…”

“…As hypothalamic dysfunction is the major cause of death and serious morbidity following CP surgery, an accurate preoperative definition of the specific anatomical CP-hypothalamus relationship is essential to plan the most appropriate surgical approach and degree of excision for each case. Regarding this issue, we have recently showed that conventional preoperative MRI studies can reliably predict the accurate CP topography and CP-hypothalamus adhesion pattern to be found in the surgical procedure [8,9]. The aim of this review is to present a critical overview of gathered knowledge on topographical and pathological concepts regarding to CPs that should be considered when planning surgical treatment of these complex lesions.…”