Surgical management of the recurrence and regrowth of craniopharyngiomas

Minamida, Yoshihiro; Mikami, Takeshi; Hashi, Kazuo; Houkin, Kiyohiro

doi:10.3171/jns.2005.103.2.0224

Cited by 95 publications

(97 citation statements)

References 52 publications

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“…Although certain to provide worse endocrine outcomes, in the long term, this practice may benefit the patient by reducing recurrence rates. 28 As an initial evaluation of the endoscopic EEA technique, this series shows it to be effective in chiasmal decompression. Although published studies have reported rates of postoperative visual decline ranging from 2 to 15%, 5,6,26,32,34,35 there were no such occurrences in this series.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series

Gardner

Kassam

Snyderman

et al. 2008

JNS

275

229

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Object. Craniopharyngiomas are challenging tumors that most frequently occur in the sellar or suprasellar regions. Microscopic transsphenoidal resections with various extensions and variations have been performed with good results. The addition of the endoscope as well as the further expansion of the standard and extended transsphenoidal approaches has not been well evaluated for the treatment of this pathological entity.Methods. The authors performed a retrospective review of all patients who underwent a purely endoscopic, expanded endonasal approach (EEA) for the resection of craniopharyngiomas at their institution between June 1999 and February 2006. Endocrine and ophthalmological outcomes, extent of resection, and complications were evaluated.Results. Sixteen patients underwent endoscopic EEA for the resection of craniopharyngiomas. Five patients (31%) presented with recurrent disease. Complete resection was planned in 11 of the 16 patients. Three elderly patients with vision loss underwent planned debulking, 1 patient with vision loss and a moderate-sized tumor had express wishes for debulking, and 1 patient had a separate, third ventricular nodule that was not resected. Of those in whom complete resection was planned, 91% underwent near-total (2/11) or gross-total (8/11) resection. No patient who underwent gross-total resection suffered a recurrence. The mean follow-up period was 34 months. Of the 14 patients who presented with vision loss, 93% had improvement or complete recovery and 1 patient's condition remained stable. No patient experienced visual worsening. Eighteen percent of patients (without preexisting hypopituitarism) developed panhypopituitarism and 8% developed permanent diabetes insipidus. There were no cases of new obesity. The postoperative cerebrospinal fluid leak rate was 58%. All leaks were resolved, and there were no cases of bacterial meningitis. There was 1 vascular injury (posterior cerebral artery perforator branch) resulting in the only new neurological deficit. No patient died.Conclusions. Endoscopic EEA for the resection of craniopharyngiomas provides acceptable results and holds the potential to improve outcomes. comparing these results with those previously published for other approaches, we hope to better judge both approaches in terms of their respective advantages and disadvantages.Although authors of many past studies have assessed craniopharyngioma resection via a transsphenoidal route, 2,17,23,24,29 few 7 have used a purely endoscopic technique and most are biased toward the resection of tumors with minimal supra-or parasellar extension. Our series consists of tumors located above and/or with extension superior and lateral to the sella, superior and posterior to the chiasm, and even extending into the third ventricle. MethodsAfter obtaining institutional review board approval, we reviewed the medical records and imaging studies of all patients with the histopathological diagnosis of craniopharyngioma treated via an EEA between June 1999 and February 2006. No patient was e...

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Section: Discussionmentioning

confidence: 99%

Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series

Gardner

Kassam

Snyderman

et al. 2008

JNS

275

229

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“…Table 1 summarizes outcomes for the largest CP surgical series in which the results were compared between primary and recurrent cases. 3,5,7,8,[10][11][12][13]15,27,29,32 Although comparative evaluation among the cases in these series is complicated by their variable epidemiological composition and lack of validated parameters defining total removal, good outcome, and perioperative mortality, a uniform tendency toward a different outcome for primary and recurrent CPs can be recognized. The rate of radical excision falls dramatically for recurrent CPs, and operative mortality substantially increases for recurrent tumors.…”

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confidence: 99%

“…In most series, it is simply and vaguely stated that the worse outcome for recurrent CPs is largely attributed to the difficulties in tumor dissection posed by scarring from previous surgeries. 12,15,29 Accordingly, the process of scarring induced by surgical maneuvers or dissection is believed to represent the explanation for the firm adherence usually found between recurrent CPs and contiguous neurovascular structures. 27,28 Undoubtedly, adhesion strength and extent of tumor play fundamental roles in the possibility of achieving safe surgical removal of recurrent CPs, yet the underlying factors for the heterogeneous types of attachment among CPs have not been properly tackled.…”

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confidence: 99%

Craniopharyngioma recurrence: the impact of tumor topography

Prieto

Castro-Dufourny

Carrasco

et al. 2016

JNS

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“…The capacity to extend into several anatomical compartments, such as the third ventricle and interpeduncular cistern, as well as adhere to adjacent neurovascular structures makes resection a challenge. 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.…”

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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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Surgical management of the recurrence and regrowth of craniopharyngiomas

Cited by 95 publications

References 52 publications

Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series

Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series

Craniopharyngioma recurrence: the impact of tumor topography

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

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