Surgical treatment of ectopic recurrence of craniopharyngioma

Elliott, Robert E.; Moshel, Yaron A.; Wisoff, Jeffrey H.

doi:10.3171/2009.3.peds0948

Cited by 31 publications

(13 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be noted that some patients in this series were included in other reports on various aspects of the management of craniopharyngiomas in children. [20][21][22][23]58,66,70,71 A GTR was the primary aim of treatment in all children and was defined as the lack of residual tumor on visual inspection intraoperatively and no residual soft-tissue mass or enhancement suspected to be tumor on postoperative imaging, as determined by an independent neuroradiologist. The outcome variables measured included BMI (weight [in kilograms]/height 2 [in square meters]) with Z scores (SDs), 56 endocrine replacement regimen, VA and VF testing performed pre-and postoperatively by pediatric ophthalmologists, neurological examination pre-and postoperatively, subsequent seizures requiring medications, and highest level of education attained and need for educational assistance.…”

Section: Patient Populationmentioning

confidence: 99%

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Elliott¹,

Sands

Strom³

et al. 2010

FOC

Self Cite

View full text Add to dashboard Cite

Object Controversy persists concerning the optimal treatment of craniopharyngiomas in children, and no standard outcome metric exists for comparison across treatment modalities, nor is there one that adequately reflects the multisystem dysfunction that may arise. Methods The authors retrospectively analyzed the records of 86 consecutive children who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. Excluding 3 perioperative deaths and 3 patients with inadequate follow-up, 80 children (34 girls and 46 boys; mean age 9.56 years; mean follow-up 9.6 years) composed the study group (53 primary and 27 previously treated/recurrent tumors). Building on existing classification schemes proposed by De Vile for hypothalamic dysfunction and Wen for overall functional outcome, the authors devised a more nuanced classification system (Craniopharyngioma Clinical Status Scale [CCSS]) that assesses outcome across 5 axes, including neurological examination, visual status, pituitary function, hypothalamic dysfunction, and educational/occupational status at last follow-up (there is a 4-tiered grading scale in each domain, with increasing values reflecting greater dysfunction). Results There was a significant increase in pituitary dysfunction following treatment—consistent with the high rates of diabetes insipidus and hypopituitarism common to the surgical management of craniopharyngiomas—and less dramatic deterioration in hypothalamic function or cognitive domains. Significant improvement in vision was also demonstrated, with no significant overall change in neurological status. Preoperative CCSS scores predicted postoperative outcome better than clinical characteristics like patient age, sex, tumor size, and the location or presence of hydrocephalus. Conclusions Preoperative CCSS scores predicted outcome with higher accuracy than clinical or imaging characteristics. In lieu of randomized trials, the CCSS may provide a useful outcome assessment tool for comparison across treatment paradigms and surgical approaches. Long-term follow-up is critical to the analysis of outcomes of craniopharyngioma treatment, given the often-delayed sequelae of all therapies and the high recurrence rates of these tumors.

show abstract

Section: Patient Populationmentioning

confidence: 99%

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Elliott¹,

Sands

Strom³

et al. 2010

FOC

Self Cite

View full text Add to dashboard Cite

show abstract

“…The lesion proved to be an adamantinomatous craniopharyngioma like the one that had been previously removed (Kordes et al, 2011). Other case reports have documented similar seeding of tumor cells distant from the original tumor site along the surgical path (Ragoowansi and Piepgras, 1991;Lee et al, 1999;Novegno et al, 2002;Ishii et al, 2004;Kawaguchi et al, 2005;Jeong et al, 2006;Yamada et al, 2006;Bikmaz, 2009;Elliott, 2009;Romani et al, 2010;Blank, 2011;Elfving et al, 2011;Jakobs and Orakcioglu, 2012). It is clear from these reports that craniopharyngioma cells have the ability to remain viable after excision, and that if implanted along the surgical tract can potentially create a second lesion (see Table 31.1).…”

Section: Ectopic Craniopharyngiomasmentioning

confidence: 89%

Ectopic Occurrence of Craniopharyngiomas

Uribe

Brem²,

Jallo³

2015

Craniopharyngiomas

View full text Add to dashboard Cite

“…Of note, some patients in this series were included in other reports on various aspects of the management of craniopharyngiomas in children. [14][15][16][17]48,[55][56][57] Ten cases were excluded for the following reasons: less than 1 year of follow-up imaging (6), perioperative death (3), and nonsuprasellar tumors (1). Data were retrospectively collected on the remaining 76 cases to determine the risk factors for and the rate and clinical significance of FDCA.…”

Section: Methodsmentioning

confidence: 99%

Fusiform dilation of the carotid artery following radical resection of pediatric craniopharyngiomas: natural history and management

Elliott

Wisoff

2010

FOC

Self Cite

View full text Add to dashboard Cite

Object Fusiform dilation of the supraclinoid internal carotid artery (FDCA) is a reported occurrence following surgery for suprasellar tumors, in particular craniopharyngiomas. We report our experience of the incidence and natural history of FDCA following aggressive surgical resection of craniopharyngiomas in children. Methods Between 1986 and 2006, 86 patients under the age of 21 underwent radical resection of craniopharyngiomas at our institution. Ten cases with < 1 year of follow-up imaging (6), perioperative death (3), or nonsuprasellar tumors (1) were excluded. Data were retrospectively collected on the remaining 76 patients (43 male, 33 female; mean age 9.5 years; mean tumor size 3.3 cm) to determine the risk factors for and the rate and clinical significance of FDCA. Results Fifty patients had primary tumors and 26 patients received treatment before referral to our center. Sixty-six children (87%) had gross-total resection. At a mean follow-up time of 9.9 years, FDCA had developed in 7 patients (9.2%), all of whom had primary tumors and gross-total resection. The mean time to onset of FDCA was 6.8 months (range 3–11 months) with stabilization occurring at mean of 17.7 months (range 9–29.5 months). The mean size of the aneurysms was 9.1 mm (range 7.1–12 mm). After arrest, no lesions showed continued growth on serial imaging or produced symptoms or required treatment. There were no significant differences in age, sex, tumor size, pre- or retrochiasmatic location, extent of resection, or surgical approach (p > 0.05) between patients with and without FDCA. Conclusions Fusiform dilation of the supraclinoid internal carotid artery occurred in almost 10% of children following radical resection of craniopharyngiomas. In agreement with other reports, the authors concluded that FDCA probably occurs as a result of surgical manipulation of the supraclinoid carotid artery and should be managed conservatively because very few patients exhibit continued symptoms or experience growth or rupture of the lesion.

show abstract

Surgical treatment of ectopic recurrence of craniopharyngioma

Cited by 31 publications

References 62 publications

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Ectopic Occurrence of Craniopharyngiomas

Fusiform dilation of the carotid artery following radical resection of pediatric craniopharyngiomas: natural history and management

Contact Info

Product

Resources

About