Somnolence in adult craniopharyngioma patients is a common, heterogeneous condition that is potentially treatable

Crowley, Rachel; Woods, C. G.; Fleming, Mark D.; Rogers, Bairbre; Behan, Lucy Ann; O’Sullivan, Eoin; Kane, Thomas M.; Agha, Amar; Smith, Debbie; Costello, Richard W.; Thompson, C. J.

doi:10.1111/j.1365-2265.2011.03993.x

Cited by 40 publications

(62 citation statements)

References 32 publications

(60 reference statements)

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“…Modafinil is a wake-promoting agent that has shown beneficial effects in adults with Cp-related hypersomnolence (Crowley et al, 2011). We have offered this medication to two patients with hypothalamic obesity (HO) and significant daytime fatigue related to treatment for tumors in the hypothalamic area.…”

Section: Sleep Dysregulationmentioning

confidence: 99%

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

Cohen¹,

Guger²,

Hamilton³

2011

Front. Endocrin.

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Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary–hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive, and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue, and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend toward less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates.

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Section: Sleep Dysregulationmentioning

confidence: 99%

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

Cohen¹,

Guger²,

Hamilton³

2011

Front. Endocrin.

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“…A loss of temperature control (very low temperature) was recorded in adult CP patients after surgery for a CP (32). Somnolence is common in adult CP patients and in the majority due to sleep apnoea (33), and disorders of sleep pattern and excessive daytime sleepiness have been recorded in up to one-third of adult CP patients (34). Fatal outcome was recorded in an adult CP patient (35) after GTR together with CRT of a large hypothalamic CP.…”

Section: Thirst Disorder Thermoregulatory Disorders Somnolence and mentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5-2.0 cases/million per year and approximately 60% of CP is seen in adulthood. The therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. Typical initial manifestations at diagnosis in children are symptoms of elevated intracranial pressure, visual disturbances and hypopituitarism. CPs have the highest mortality of all pituitary tumours. The standardised overall mortality rate varies from 2.88 to 9.28 in cohort studies. Adults with CP have a 3-19-fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health and reduction in quality of life and cognitive function.

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“…This can explain the paucity of attention paid to these alterations in the current literature on craniopharyngiomas affecting the third ventricle. 1,5,6,9,14,16,22,28 In our series, postoperative outcome after the EEA is encouraging, with complete recovery of sleep efficiency in 50% of cases and normalization or improvement of BCT rhythm in 5 of 6 cases with preoperative disturbances. Furthermore, only 1 patient presented with a de novo onset of temperature rhythm alteration at follow-up.…”

Section: Discussionmentioning

confidence: 76%

“…[2][3][4]8,21 However, few data about the outcome of the functions involving the hypothalamus after surgery are available, and in particular data regarding the body core temperature (BCT) rhythm and sleep-wake cycle. 1,5,6,9,11,15,22,28 The aim of this study was to investigate the outcome of the BCT rhythm and sleep-wake cycle dysfunctions in patients with craniopharyngiomas involving the third ventricle undergoing operation via an EEA.…”

mentioning

confidence: 99%

Postoperative outcome of body core temperature rhythm and sleep-wake cycle in third ventricle craniopharyngiomas

Zoli

Sambati

Milanese

et al. 2016

FOC

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OBJECTIVE One of the more serious risks in the treatment of third ventricle craniopharyngiomas is represented by hypothalamic damage. Recently, many papers have reported the expansion of the indications for the endoscopic endonasal approach (EEA) to be used for these tumors as well. The aim of this study was to assess the outcome of sleep-wake cycle and body core temperature (BCT), both depending on hypothalamic control, in patients affected by craniopharyngiomas involving the third ventricle that were surgically treated via an EEA. METHODS All consecutive adult patients with craniopharyngiomas that were treated at one center via an EEA between 2014 and 2016 were prospectively included. Each patient underwent neuroradiological, endocrinological, and ophthalmological evaluation; 24-hour monitoring of the BCT rhythm; and the sleep-wake cycle before surgery and at follow-up of at least 6 months. RESULTS Ten patients were included in the study (male/female ratio 4:6, mean age 48.6 years, SD 15.9 years). Gross-total resection was achieved in 8 cases. Preoperative BCT rhythm was pathological in 6 patients. After surgery, these disturbances resolved in 2 cases, improved in another 3, and remained the same in 1 patient; also, 1 case of de novo onset was observed. Before surgery the sleep-wake cycle was pathological in 8 cases, and it was restored in 4 patients at follow-up. After surgery the number of patients reporting diurnal naps increased from 7 to 9. CONCLUSIONS The outcome of the sleep-wake cycle and BCT analyzed after EEA in this study is promising. Despite the short duration of the authors' experience, they consider these results encouraging; additional series are needed to confirm the preliminary findings.

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Somnolence in adult craniopharyngioma patients is a common, heterogeneous condition that is potentially treatable

Abstract: Somnolence is common in craniopharyngioma patients and in the majority is because of obstructive sleep apnoea. An additional group of somnolent craniopharyngioma patients benefits from modafinil.

Cited by 40 publications

References 32 publications

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

Endocrine aspects and sequel in patients with craniopharyngioma

Postoperative outcome of body core temperature rhythm and sleep-wake cycle in third ventricle craniopharyngiomas

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