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Colliander R, Sharma S, Shlobin NA, Fernandez LG, LoPresti MA, Lam S, DeCuypere M. Visual outcomes after treatment of craniopharyngioma in children: A systematic review. Childs Nerv Syst 2024; 40:1641-1659. [PMID: 38416204 DOI: 10.1007/s00381-024-06328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality. METHODS A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies. RESULTS A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated. CONCLUSION OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.
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Affiliation(s)
- Reid Colliander
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Shelly Sharma
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Luis G Fernandez
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Melissa A LoPresti
- Division of Pediatric Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
- Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Michael DeCuypere
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
- Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Wong AK, Raviv J, Wong RH. Endoscopic Transsphenoidal Resection of Cystic Third Ventricular Craniopharyngioma with Cystocisternal Fenestration. World Neurosurg 2024; 185:224. [PMID: 38401755 DOI: 10.1016/j.wneu.2024.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
Cystic craniopharyngiomas of the third ventricle can be challenging to treat because complete resection of the cyst wall can be associated with hypothalamic dysfunction and minimal rostral displacement of the optic chiasm leads to a small endonasal operative corridor. Various methods to overcome the frequent recurrences have been described, such as intracystic bleomycin or catheter placement, with mixed results.1-12 In Video 1, we describe a simple cystocisternal fenestration technique with preservation of the rostral cyst wall via an endoscopic endonasal approach where the solid portion of the tumor is resected, and the inferior wall of the cyst is opened into the prepontine cistern and the superior wall of the cyst and adjacent third ventricle are preserved. This allows for ventricular pressure to collapse the cyst cavity in the postoperative period. In select patients where safe complete resection of a cystic craniopharyngioma is prohibitive, this may provide a durable treatment and can be performed through a small endonasal corridor below a nondisplaced optic chiasm.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University, Chicago, Illinois, USA
| | - Joseph Raviv
- Department of Otolaryngology, NorthShore University Health System, Evanston, Illinois, USA
| | - Ricky H Wong
- Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA.
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Kulkarni A, Konar S, Shukla D, Sadashiva N, Devi BI. Transventricular Endoscopic Approach for Cystic Craniopharyngioma: Case Series. J Neurol Surg B Skull Base 2023; 84:591-597. [PMID: 37854531 PMCID: PMC10581829 DOI: 10.1055/a-1934-9307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022] Open
Abstract
Background and Study Aims The treatment of craniopharyngioma is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to describe a personal experience with this method of treatment. Material and Methods This is a retrospective review of a series of patients managed with endoscopic catheter and reservoir placement for cystic craniopharyngiomas. Results Twenty-nine patients presented with clinical features of raised intracranial features. Imaging showed a predominantly cystic craniopharyngioma extending into the third ventricle with hydrocephalus. All patients underwent transcortical transventricular endoscopic biopsy, and catheter placement connected to a reservoir. There was no morbidity ascribed to the endoscopic procedure when fenestration and aspiration or fenestration and reservoir were placed. Twelve patients underwent radiotherapy. The median duration of follow-up was 18 months (3-72 months). Eight (27.5%) cases had recurrences. Five (17.2%) could be managed with only reaspiration, two (6.8%) required craniotomy and resection, and one (3.4%) could be managed only with ventriculoperitoneal shunt. Conclusion The neuroendoscopic fenestration, aspiration of cyst, and placement of catheter reservoir followed by radiation is an optional treatment for predominantly cystic craniopharyngiomas arising within or extending into the third ventricle causing hydrocephalus.
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Affiliation(s)
- Akshay Kulkarni
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, United States
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Agosti E, Saraceno G, Rampinelli V, Raffetti E, Veiceschi P, Buffoli B, Rezzani R, Giorgianni A, Hirtler L, Alexander AY, Deganello A, Piazza C, Nicolai P, Castelnuovo P, Locatelli D, Peris-Celda M, Fontanella MM, Doglietto F. Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa. Oper Neurosurg (Hagerstown) 2022; 23:e256-e266. [PMID: 36106936 DOI: 10.1227/ons.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described. OBJECTIVE To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF. METHODS Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II-UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses. RESULTS EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs. CONCLUSION Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.
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Affiliation(s)
- Edoardo Agosti
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Saraceno
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Center for Natural Hazards and Disaster Science, Uppsala University, Uppsala, Sweden
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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