Surgical Outcome in 90 Patients with Craniopharyngioma: An Evaluation of Transsphenoidal Surgery

Yamada, Shozo; Fukuhara, Noriaki; Oyama, Kenichi; Takeshita, Akira; Takeuchi, Yasuharu; Itô, Junko; Inoshita, Naoko

doi:10.1016/j.wneu.2010.06.014

Cited by 90 publications

(80 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8,12 Several studies have reported that the rate of radical resection in repeat surgeries is markedly lower than that in primary surgeries and that there is increased perioperative morbidity and mortality for the repeat surgery cases. 6,25 In the present study, 32 patients (44.4%) had undergone previous surgical procedures at other institutions, and 35 (48.6%) of the 72 tumors were classified as the retrochiasmatic type. When using the various approaches based on our anatomical subclassification, we found that GTR or NTR was achieved in 40 (100%) of the 40 primary cases and in 31 (96.9%) of the 32 recurrent cases.…”

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 59%

“…Table 6 lists the surgical approaches utilized in previous large series. 4,6,8,10,21,24,25 We created a lesion classification that could be used to determine the most appropriate surgical approach. Lesion identification and the approach used during the resections were as follows.…”

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 99%

“…Table 6 lists the surgical outcomes of previous large series. 4,6,8,10,21,24,25 The craniopharyngioma radical resection rates have been found to be 40%-90%, with a retrochiasmatic location, larger size, calcification > 10%, extension into the third ventricle, and recurrence reported to be significant prognostic factors that negatively affect the extent of resection. 8,12 Several studies have reported that the rate of radical resection in repeat surgeries is markedly lower than that in primary surgeries and that there is increased perioperative morbidity and mortality for the repeat surgery cases.…”

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 99%

“…However, the optimal surgical approach remains controversial. 4,6,8,10,12,21,24,25 AbbreviAtioNs GTR = gross-total resection; KPS = Karnofsky Performance Scale; NTR = near-total resection; PR = partial resection; STR = subtotal resection; VIS = visual impairment score. objeCtive Craniopharyngiomas remain a particularly formidable challenge in the neurosurgical field.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Aggressive surgery based on an anatomical subclassification of craniopharyngiomas

Morisako

Goto

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE Craniopharyngiomas remain a particularly formidable challenge in the neurosurgical field. Because these lesions involve the hypothalamus and ophthalmological systems, their resection is associated with either higher rates of mortality and recurrence or a lower rate of radical resection. The authors report the outcomes of aggressive surgeries based on an anatomical subclassification of craniopharyngiomas. METHODS Clinical and ophthalmological examinations, imaging studies, endocrinological studies, neuropsychological function, and surgical complications in all patients who had undergone microsurgical resection for craniopharyngioma at Osaka City University hospital between January 2000 and December 2014 were retrospectively reviewed through the medical records. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor origin. The 4 possible groups included the intrasellar type, prechiasmatic type, retrochiasmatic type, and intra–third ventricle type. A multistage surgery was planned in some cases. RESULTS Seventy-two cases of craniopharyngioma were resected. Thirty-two patients (44.4%) had undergone previous surgical procedures at other institutions. Thirty-five cases (48.6%) were classified as retrochiasmatic, 19 (26.4%) as prechiasmatic, 12 (16.7%) as intra–third ventricle, and 6 (8.3%) as intrasellar. In 26 cases (36.1%), multistage surgery was required to complete the radical resection. Overall, 41 cases involved an orbitozygomatic approach; 21, a transpetrosal approach; 21, an interhemispheric approach; and 14, a transsphenoidal approach. In 3 cases, other approaches were applied. Gross-total resection was achieved in 43 patients (59.7%), near-total resection in 28 (38.9%), and partial resection in only 1 patient (1.4%). The mean follow-up period after resection was 4.7 years. Tumor recurrence or regrowth occurred in 15 (20.8%) of the 72 patients, with 14 of the 15 cases successfully controlled after additional resections and stereotactic radiosurgery. However, 1 patient died of uncontrollable tumor progression, and 2 patients died of unrelated diseases during the follow-up. Overall, disease in 69 (95.8%) of 72 patients was well controlled at the last follow-up. CONCLUSIONS Aggressive tumor resection is the authors' treatment policy for craniopharyngioma. Using an anatomical subclassification of craniopharyngioma to choose the most appropriate surgical approach is helpful in achieving that goal of aggressive resection.

show abstract

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 59%

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 99%

Section: Criteria For Selecting Surgical Approaches Based On An Anatomentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Aggressive surgery based on an anatomical subclassification of craniopharyngiomas

Morisako

Goto

et al. 2016

FOC

View full text Add to dashboard Cite

show abstract

“…7,17,46 More recent series in which pedicled nasoseptal flap was used have reported CSF leak rates less than 10%, and even between 0% and 4% in some more recent series. 20,33,34,51 Koutourousiou et al found a CSF leak rate of 58.8% among patients who did not undergo a flap reconstruction, whereas they found a CSF leak rate of 10.6% among patients who did have a vascularized flap reconstruction. 30 As of 2011, we have routinely used a nasoseptal flap in all EETS cases, with a reduced rate of CSF leak of 14%, and with no leaks in our last 7 patients.…”

Section: Postoperative Csf Leaksmentioning

confidence: 99%

Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study

Jeswani¹,

Nuño²,

Wu³

et al. 2016

JNS

View full text Add to dashboard Cite

Surgeons have advocated for both approaches, and at present there is no consensus whether one approach is superior to the other. The authors therefore compared surgical outcomes between craniotomy and endoscopic endonasal transsphenoidal surgery (EETS) for suprasellar tumors treated at their institution. methods A retrospective review of patients undergoing resection of suprasellar lesions at Cedars-Sinai Medical Center between 2000 and 2013 was performed. Patients harboring suspected craniopharyngioma were selected for extensive review. Other pathologies or predominantly intrasellar masses were excluded. Cases were separated into 2 groups, based on the surgical approach taken. One group underwent EETS and the other cohort underwent craniotomy. Patient demographic data, presenting symptoms, and previous therapies were tabulated. Preoperative and postoperative tumor volume was calculated for each case based on MRI. Student t-test and the chi-square test were used to evaluate differences in patient demographics, tumor characteristics, and outcomes between the 2 cohorts. To assess for selection bias, 3 neurosurgeons who did not perform the surgeries reviewed the preoperative imaging studies and clinical data for each patient in blinded fashion and indicated his/her preferred approach. These data were subject to concordance analysis using Cohen's kappa test to determine if factors other than surgeon preference influenced the choice of surgical approach. results Complete data were available for 53 surgeries; 19 cases were treated via EETS, and 34 were treated via craniotomy. Patient demographic data, preoperative symptoms, and tumor characteristics were similar between the 2 cohorts, except that fewer operations for recurrent tumor were observed in the craniotomy cohort compared with EETS (17.6% vs 42.1%, p = 0.05). The extent of resection was similar between the 2 groups (85.6% EETS vs 90.7% craniotomy, p = 0.77). An increased rate of cranial nerve injury was noted in the craniotomy group (0% EETS vs 23.5% craniotomy, p = 0.04). Postoperative CSF leak rate was higher in the EETS group (26.3% EETS vs 0% craniotomy, p = 0.004). The progression-free survival curves (log-rank p = 0.99) and recurrence rates (21.1% EETS vs 23.5% craniotomy, p = 1.00) were similar between the 2 groups. Concordance analysis of cases reviewed by 3 neurosurgeons indicated that individual surgeon preference was the only factor that determined surgical approach (kappa coefficient -0.039, p = 0.762) coNclusioNs Surgical outcomes were similar for tumors resected via craniotomy or EETS, except that more CSF leaks occurred in the EETS cohort, whereas more neurological injuries occurred in the craniotomy cohort. Surgical approach appears to mostly reflect surgeon preference rather than specific tumor characteristics. These data support the view that EETS is a viable alternative to craniotomy, providing a similar extent of resection with less neurological injury.

show abstract

Craniopharyngioma

Devin¹

2013

Pituitary Disorders

View full text Add to dashboard Cite

Surgical Outcome in 90 Patients with Craniopharyngioma: An Evaluation of Transsphenoidal Surgery

Cited by 90 publications

References 31 publications

Aggressive surgery based on an anatomical subclassification of craniopharyngiomas

Aggressive surgery based on an anatomical subclassification of craniopharyngiomas

Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study

Craniopharyngioma

Contact Info

Product

Resources

About