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Webb KL, Pruter WW, Hinkle ML, Walsh MT. Comparing Surgical Approaches for Craniopharyngioma Resection Among Adults and Children: A Meta-analysis and Systematic Review. World Neurosurg 2023; 175:e876-e896. [PMID: 37062335 DOI: 10.1016/j.wneu.2023.04.037] [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: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Craniopharyngioma treatment often necessitates surgical resection. Conventional approaches, such as transcranial and transsphenoidal approaches, are predominantly used. However, a recently adopted supraorbital approach may be more efficacious. Thus, this meta-analysis and systematic review aimed to compare the efficacy of the transcranial, transsphenoidal, and supraorbital approaches for resection and treatment of craniopharyngiomas. METHODS This study was performed following PRISMA guidelines. Analyses were performed according to study design: (1) analyses for studies comparing several surgical approaches; and (2) analyses of all included studies. Random effects meta-analysis models were used to pool odds ratios among studies comparing several approaches. Similarly, categorical meta-regression models were used to examine the effect of surgical approach as a covariate of outcome data for all studies. Statistics were performed using Comprehensive Meta-Analysis software (CMA 3.3, Biostat, Englewood, NJ) (significance set at P < 0.05). RESULTS Patients were well-matched for age, sex, and preoperative comorbidities between groups stratified by surgical approach. Analyses including 22 studies that compared several approaches demonstrated that the transsphenoidal group had a greater occurrence of postoperative visual improvement (P < 0.0001), lesser occurrence of visual deterioration (P < 0.0001), and lower tumor recurrence rate (P = 0.015) compared with the transcranial group. Only 2 studies compared the supraorbital approach to another approach, limiting analyses. Analyses including all studies demonstrated that the supraorbital group did not differ to either the transcranial or transsphenoidal group for any examined variables. CONCLUSIONS The present study suggests that the transsphenoidal approach is associated with improved clinical outcomes for craniopharyngioma resection. There are limited data regarding the supraorbital approach, warranting future investigation.
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Affiliation(s)
- Kevin L Webb
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Wyatt W Pruter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mickayla L Hinkle
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael T Walsh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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2
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Lin PC, Chen PY, Wei KC, Lin JH, Lin MR, Wang HC, Chiu HY. Sleep disturbance in adults with untreated primary brain tumors: prevalence and impact on quality of life. Sleep Biol Rhythms 2023; 21:201-209. [PMID: 38469283 PMCID: PMC10900047 DOI: 10.1007/s41105-022-00436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
Purpose To investigate the frequency of sleep disturbance and its effects on quality of life in adults with untreated primary brain tumors. Methods This cross-sectional study recruited 68 and 35 patients with newly diagnosed benign and malignant brain tumors, respectively. All participants completed the Chinese versions of the Athens Insomnia Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, and EORTC-QLQ-BN20 for quality-of-life assessment. An actigraph was used to measure sleep parameters [e.g., dichotomy index (I < O)], for at least 3 consecutive days in untreated status. Results The majority of the patients with benign and malignant tumors had meningioma (57.4%) and glioblastoma (40%), respectively. The prevalence of insomnia, poor sleep quality, and excessive daytime sleepiness was 59.2%, 77.7%, and 4.9%, respectively. The prevalence rates of sleep disturbances were not affected by tumor locations (suprasellar vs. non-suprasellar tumors) and tumor types (benign vs. malignant tumors). Only 36 participants completed actigraphy assessments (I < O = 95.4) due to having a tight schedule, actigraph malfunction, or not having the habit of wearing a wristwatch; 61% of them experienced circadian rhythm disruption (I < O ≤ 97.5). Insomnia was the only sleep parameter that significantly affected quality of life after controlling for potential confounders (B = 0.54, p = 0.03, adjusted R2 = 0.60). Conclusion More than 60% of the patients with primary malignant and benign brain tumors experienced insomnia, poor sleep quality, and circadian rhythm disruption. Insomnia was independently correlated with quality of life in untreated status. Health-care providers can apply these findings to design effective interventions targeting sleep disturbance to improve quality of life in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00436-y.
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Affiliation(s)
- Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Neurosurgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei, Taiwan
| | - Jian-her Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Mei-Ru Lin
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry and Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
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3
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Agresta G, Campione A, Veiceschi P, Gallo D, Agosti E, Massimi L, Piatelli G, Consales A, Linsler S, Oertel J, Pozzi F, Tanda ML, Castelnuovo P, Locatelli D. Clinical and oncological outcomes in single-stage versus staged surgery for pediatric craniopharyngiomas: a multicenter retrospective study. J Endocrinol Invest 2022; 46:1219-1232. [PMID: 36550264 DOI: 10.1007/s40618-022-01993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Craniopharyngiomas (CPGs) are aggressive brain tumors responsible of severe morbidity in children. The best treatment strategies are under debate. Our study evaluates surgical, pituitary, and hypothalamic outcomes of a tailored staged-surgical approach compared to a single-stage radical approach in children with CPGs. METHODS Multicenter retrospective study enrolling 96 children treated for CPGs in the period 2010-2022. The surgical management was selected after a multidisciplinary evaluation. Primary endpoint includes the inter-group comparison of preservation/improvement of hypothalamic-pituitary function, the extent of resection, and progression-free survival (PFS). Secondary endpoints include overall survival (OS), morbidity, and quality of life (QoL). RESULTS Gross Total Resection (GTR) was reached in 46.1% of cases in the single-stage surgery group (82 patients, age at surgery 9 ± 4.7 years) and 33.3% after the last operation in the staged surgery group (14 patients age 7.64 ± 4.57 years at first surgery and 9.36 ± 4.7 years at the last surgery). The PFS was significantly higher in patients addressed to staged- compared to single-stage surgery (93.75% vs 70.7% at 5 years, respectively, p = 0.03). The recurrence rate was slightly higher in the single-stage surgery group. No significant differences emerged in the endocrinological, visual, hypothalamic outcome, OS, and QoL comparing the two groups. CONCLUSIONS In pediatric CPGs' surgical radicality and timing of intervention should be tailored considering both anatomical extension and hypothalamic-pituitary function. In selected patients, a staged approach offers a safer and more effective disease control, preserving psychophysical development.
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Affiliation(s)
- G Agresta
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy.
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy.
| | - A Campione
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - P Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - D Gallo
- Endocrinology Unit, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - E Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - L Massimi
- Pediatric Neurosurgery Unit, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - G Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Consales
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Linsler
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - J Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - F Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
| | - M L Tanda
- Endocrinology Unit, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - D Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Luigi Borri, 57, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center, University of Insubria, Luigi Borri, 57, 21100, Varese, Italy
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Zoli M, Guaraldi F, Zenesini C, Acciarri N, Sollini G, Asioli S, Faustini-Fustini M, Agati R, Cirillo L, Tonon C, Lodi R, Pasquini E, Mazzatenta D. Role of endoscopic endonasal approach for craniopharyngiomas extending into the third ventricle in adults. BRAIN & SPINE 2022; 2:100910. [PMID: 36248121 PMCID: PMC9560538 DOI: 10.1016/j.bas.2022.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/21/2022] [Accepted: 06/25/2022] [Indexed: 06/16/2023]
Abstract
•EAA is an innovative, promising, safe and effective approach for 3VCPs.•Key of success is surgeon learning curve in endoscopy and patients selection.•With correct indications, EEA gives GTR and morbidity rate similar to other routes.•Clinical, tumoral and anatomical features should be considered for EEA selection.
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Affiliation(s)
- Matteo Zoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Federica Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epidemiology and Statistics Unit, Bologna, Italy
| | - Nicola Acciarri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Giacomo Sollini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- Azienda USL di Bologna, Anatomic Pathology Unit, Bellaria Hospital, Bologna, Italy
| | - Marco Faustini-Fustini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Raffaele Agati
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroradiologia con Tecniche ad Elevata Complessità, Bologna, Italy
| | - Luigi Cirillo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ernesto Pasquini
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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5
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Cordani R, Veneruso M, Napoli F, Di Iorgi N, Milanaccio C, Consales A, Disma N, De Grandis E, Maghnie M, Nobili L. Sleep Disturbances in Pediatric Craniopharyngioma: A Systematic Review. Front Neurol 2022; 13:876011. [PMID: 35651342 PMCID: PMC9150678 DOI: 10.3389/fneur.2022.876011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Craniopharyngiomas are rare brain tumors of the sellar region and are the most common non-neuroepithelial intracerebral neoplasm in children. Despite a low-grade histologic classification, craniopharyngiomas can have a severe clinical course due to hypothalamic involvement. The hypothalamus plays a crucial role in regulating vital functions, and it is a critical component of the sleep-wake regulatory system. This systematic review aims to provide an overview of the current knowledge on sleep disorders in patients with craniopharyngioma to unravel their underlying mechanisms and identify possible therapeutic strategies. A comprehensive electronic literature search of the PubMed/MEDLINE and Scopus databases was conducted in accordance with the PRISMA® statement. Extensively published, peer-reviewed articles involving patients with childhood craniopharyngioma and focused on this specific topic were considered eligible for inclusion. Thirty-two articles were included; a high prevalence of excessive daytime sleepiness was reported in CP patients, with wide variability (25–100%) depending on the diagnostic method of detection (25–43% by subjective measures, 50–100% by objective investigations). In particular, secondary narcolepsy was reported in 14–35%, sleep-disordered breathing in 4–46%. Moreover, sleep-wake rhythm dysregulation has been notified, although no prevalence data are available. Possible mechanisms underlying these disorders are discussed, including hypothalamic injury, damage to the suprachiasmatic nucleus, low melatonin levels, hypocretin deficiency, and hypothalamic obesity. The diagnosis and management of sleep disorders and associated comorbidities are challenging. This review summarizes the pathophysiology of sleep disorders in childhood-onset CP and the main treatment options. Finally, a possible diagnostic algorithm in order to accurately identify and treat sleep disorders in these patients is proposed.
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Affiliation(s)
- Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Unit for Research & Innovation in Anesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Veneruso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Flavia Napoli
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Natascia Di Iorgi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Nicola Disma
- Unit for Research & Innovation in Anesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisa De Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Mohamad Maghnie
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Lino Nobili
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6
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Pascual JM, Prieto R. Craniopharyngioma and the Third Ventricle: This Inescapable Topographical Relationship. Front Oncol 2022; 12:872689. [PMID: 35392218 PMCID: PMC8980804 DOI: 10.3389/fonc.2022.872689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
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7
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Romigi A, Feola T, Cappellano S, De Angelis M, Pio G, Caccamo M, Testa F, Vitrani G, Centonze D, Colonnese C, Esposito V, Jaffrain-Rea ML. Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update. Front Neurol 2022; 12:817257. [PMID: 35222233 PMCID: PMC8863754 DOI: 10.3389/fneur.2021.817257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
Sleep disorders (SDs) represent an important issue in patients with craniopharyngioma (CP). Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders, such as obstructive sleep apnea (OSA) and/or central hypersomnia, including secondary narcolepsy. SDs may severely reduce quality of life, increase disease-related cardiorespiratory and cardiovascular morbidity, and finally play a major role in increased long-term mortality reported on patients with CP. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop because of direct hypothalamic damage by the tumor itself and/or complications of the treatments, neurosurgery and/or radiotherapy, and typically includes permanent neuroendocrine dysfunctions, morbid obesity, and secondary metabolic disorders. Despite increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to patients with CP. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge of the pathogenesis and prevalence of SDs in patients with CP and propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for appropriate characterization of SDs, identification of risk factors, and potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs, and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in patients with CP and possible future avenues for research agenda are also considered.
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Affiliation(s)
- Andrea Romigi
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Tiziana Feola
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Cappellano
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | | | - Giacomo Pio
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Marco Caccamo
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Federica Testa
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Giuseppe Vitrani
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Diego Centonze
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Claudio Colonnese
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Vincenzo Esposito
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marie-Lise Jaffrain-Rea
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- *Correspondence: Marie-Lise Jaffrain-Rea
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8
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Lin MR, Chen PY, Wang HC, Lin PC, Lee HC, Chiu HY. Prevalence of sleep disturbances and their effects on quality of life in adults with untreated pituitary tumor and meningioma. J Neurooncol 2021; 154:179-186. [PMID: 34304334 DOI: 10.1007/s11060-021-03811-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the prevalence of sleep disturbances and their effects on quality of life in adults with pituitary tumor or meningioma. METHODS This prospective study included 33 and 44 patients with pituitary tumor and meningioma, respectively. All participants completed a series of valid questionnaires for assessing sleep and quality of life; all participants wore 3-day actigraph prior to related treatment. The actigraph-derived sleep parameters included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and dichotomy index (I < O) value. RESULTS The prevalence of insomnia, excessive daytime sleepiness, and poor sleep quality was 46.8%, 6.5%, and 81.8%, respectively. The differences in these sleep parameters between patients with pituitary tumor and those with meningioma were nonsignificant. Only 27 participants completed the actigraphic assessments. The mean I < O value was 95.99%, and nearly 60% participants exhibited circadian rhythm disruption. Sleep quality was the only sleep variable independently correlated with preoperative quality of life, even after adjustments for confounders (B = 0.80, p = 0.02). CONCLUSIONS Insomnia, poor sleep quality, and disrupted circadian rhythm are highly prevalent in adults with untreated pituitary tumor or meningioma. Sleep quality independently correlated with quality of life. We indirectly confirmed that tumor location may not be a possible cause of sleep changes.
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Affiliation(s)
- Mei-Ru Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery and Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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9
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Seo Y, Kim YH, Kim JH, Kong DS, Dho YS, Kang H, Kim KM, Kim JW, Park CK. Outcomes of the endoscopic endonasal approach for tumors in the third ventricle or invading the third ventricle. J Clin Neurosci 2021; 90:302-310. [PMID: 34275567 DOI: 10.1016/j.jocn.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/27/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
We aimed to retrospectively analyze the surgical and clinical outcomes of the endoscopic endonasal approach (EEA) for tumors in the third ventricle or invading the third ventricle. In total, 82 patients who had undergone surgical treatment using the EEA for tumors involving the third ventricle were enrolled in this study. This cohort study comprised 46 male and 36 female patients. The median age was 37 years (range, 5-76), and the median follow-up duration was 56.5 months (range, 6-117). Seventy-six patients had craniopharyngiomas, and 6 had gangliocytomas, gangliogliomas, astrocytomas, diffuse midline gliomas and lymphomas. Gross total removal was performed in 71 (86.5%) of the 82 patients, subtotal tumor removal in 7 patients and partial removal or biopsy in 4 patients. The pituitary stalk was preserved in 20 cases. Visual function improved in 40 (81.6%) of 49 patients. Endocrine function worsened in 41 (50%) of 82 patients. Hypothalamic function improved in 16 (72.7%) of 22 cases. Postoperative obesity occurred in 3 (20.0%) of 15 children and 11 (23.9%) of 46 adult patients. The postoperative cerebrospinal fluid leakage rate was 3.6%. Postoperative meningitis occurred in 18 (21.9%) cases. Permanent diabetes insipidus was identified in 73 (89.0%) of 82 patients. Tumor recurrence was observed in 10 patients (12%). The EEA appears to be a safe and effective treatment modality for tumors in the third ventricle or involving the third ventricle. However, more cases and long-term follow-up outcomes are required to confirm the clinical efficacy of the EEA.
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Affiliation(s)
- Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jung Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
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10
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Almeida JP, Kalyvas A, Mohan N, Oswari S, Takami H, Velasquez C, Asha M, Zadeh G, Gentili F. Current Results of Surgical Treatment of Craniopharyngiomas: The Impact of Endoscopic Endonasal Approaches. World Neurosurg 2021; 142:582-592. [PMID: 32987614 DOI: 10.1016/j.wneu.2020.05.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/05/2020] [Indexed: 10/23/2022]
Abstract
Surgery is the main treatment option for the management of craniopharyngiomas. Transcranial microsurgical approaches, such as pterional and subfrontal approaches, have constituted the classic operative strategy for resection of these tumors. However, the development of endoscopic endonasal approaches has revolutionized the treatment of craniopharyngiomas in the last 15 years, and endoscopic resection is favored for most craniopharyngiomas. In this article, we discuss our experience with the management of craniopharyngiomas and review the current results of the surgical treatment of those tumors, including discussion of goals of surgery, complications, recurrences, and the role of adjuvant treatment.
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Affiliation(s)
- Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aristotelis Kalyvas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nilesh Mohan
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Selfy Oswari
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hirokazu Takami
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Velasquez
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Asha
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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11
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Whittington JE, Holland AJ. Disorders of hypothalamic function: Insights from Prader-Willi syndrome and the effects of craniopharyngioma. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:381-389. [PMID: 34238472 DOI: 10.1016/b978-0-12-820683-6.00028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Either physical damage or being born with a specific genetic abnormality can impact on the functioning of the hypothalamus, resulting in diverse physical manifestations and/or specific behavior disorders. The impact of physical damage due to craniopharyngioma (CP) and/or surgery to remove a craniopharyngioma is compared and contrasted with the impact resulting from the genetic abnormalities associated with Prader-Willi syndrome (PWS). Similarities between PWS and CP posttreatment include hyperphagia and weight gain, low growth hormone levels, low bone density in adults, hypogonadism, disturbed temperature regulation, disturbed sleep and daytime sleepiness, memory difficulties, and problems with behavior and with peer relationships. These disturbances are an indication of the hypothalamus's central role in homeostasis. Most of the abnormalities appear to be more severe postoperatively in people with CP. Differences include higher ghrelin levels in PWS, complete absence of pituitary hormones in many cases of CP, higher incidence of thyroid dysfunction in CP, "growth without growth hormone" in obese children with CP, different types of diabetes (diabetes insipidus in CP and diabetes mellitus in PWS), and evidence of developmental delay and low IQ in people with PWS.
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Affiliation(s)
- Joyce E Whittington
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Anthony J Holland
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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12
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Pascual JM, Prieto R, Rosdolsky M. Craniopharyngiomas primarily affecting the hypothalamus. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:75-115. [PMID: 34238481 DOI: 10.1016/b978-0-12-820683-6.00007-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The concept of craniopharyngiomas (CPs) primarily affecting the hypothalamus, or "hypothalamic CPs" (Hy-CPs), refers, in a restrictive sense, to the subgroup of CPs originally developing within the neural tissue of the infundibulum and tuber cinereum, the components of the third ventricle floor. This subgroup, also known as infundibulo-tuberal CPs, largely occupies the third ventricle and comprises up to 40% of this pathological entity. The small subgroup of strictly intraventricular CPs (5%), lesions wholly developed within the third ventricle above an anatomically intact third ventricle floor, can also be included within the Hy-CP category. The remaining types of sellar and/or suprasellar CPs may compress or invade the hypothalamic region during their growth but will not be considered in this review. Hy-CPs predominantly affect adults, causing a wide range of symptoms derived from hypothalamic dysfunction, such as adiposogenital dystrophy (Babinski-Fröhlich's syndrome), diabetes insipidus (DI), abnormal diurnal somnolence, and a complex set of cognitive (dementia-like, Korsakoff-like), emotional (rage, apathy, depression), and behavioral (autism-like, psychotic-like) disturbances. Accordingly, Hy-CPs represent a neurobiological model of psychiatric disorders caused by a lesion restricted to the hypothalamus. The vast majority (90%) of squamous-papillary CPs belong to the Hy-CP category. Pathologically, most Hy-CPs present extensive and strong adhesions to the surrounding hypothalamus, usually formed of a thick band of gliotic tissue encircling the central portion of the tumor ("ring-like" attachment) or its entire boundary ("circumferential" attachment). CPs with these severe adhesion types associate high surgical risk, with morbidity and mortality rates three times higher than those for sellar/suprasellar CPs. Consequently, radical surgical removal of Hy-CPs cannot be generally recommended. Rather, Hy-CPs should be accurately classified according to an individualized surgery-risk stratification scheme considering patient age, CP topography, presence of hypothalamic symptoms, tumor size, and, most importantly, the CP-hypothalamus adhesion pattern.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain.
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Maria Rosdolsky
- Independent Medical Translator, Jenkintown, PA, United States
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13
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Yang L, Xie S, Tang B, Wu X, Tong Z, Fang C, Ding H, Bao Y, Zheng S, Hong T. Hypothalamic injury patterns after resection of craniopharyngiomas and correlation to tumor origin: A study based on endoscopic observation. Cancer Med 2020; 9:8950-8961. [PMID: 33141521 PMCID: PMC7724497 DOI: 10.1002/cam4.3589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The precise understanding of hypothalamic injury (HI) patterns and their relationship with different craniopharyngioma (CP) classifications remains poorly addressed. Here, four HI patterns after CP resection based on endoscopic observation were introduced. A total of 131 CP cases treated with endoscopic endonasal approach (EEA) were reviewed retrospectively and divided into four HI patterns: no-HI, mild-HI, unilateral-HI and bilateral-HI, according to intraoperative findings. The outcomes were evaluated and compared between groups in terms of weight gain, endocrine status, electrolyte disturbance and neuropsychological function before and after surgery. A systematic correlation was found between CP origin and subsequent HI patterns. The majority of intrasellar and suprasellar stalk origins lead to a no-HI pattern, the central-type CP mainly develops a mild or bilateral HI pattern, and the majority of tumors with hypothalamic stalk origins result in unilateral HI and sometimes bilateral HI patterns. The proportion of tumors with a maximum diameter >3 cm in the no-HI group was higher than that in the mild-HI group, BMI and quality of life in the no-HI group showed better results than those in the other groups. The incidence of new-onset diabetes insipidus in the bilateral-HI group was significantly higher than that in the other groups. Memory difficulty was observed mainly in the unilateral-HI and bilateral-HI groups. However, the outcomes of electrolyte disturbance, sleep, and cognitive disorder in the unilateral-HI group were significantly better than those in the bilateral-HI group. This study suggests the possibility of using pre- and intraoperative observation of CP origin to predict four HI patterns and even subsequent outcomes after tumor removal.
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Affiliation(s)
- Le Yang
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - ShenHao Xie
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Bin Tang
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xiao Wu
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - ZhiGao Tong
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Chao Fang
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Han Ding
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - YouYuan Bao
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - SuYue Zheng
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Tao Hong
- Department of NeurosurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangChina
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14
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Iyigun I, Alikasifoglu A, Gonc N, Ozon A, Eryilmaz Polat S, Hizal M, Kiper N, Ozcelik U. Obstructive sleep apnea in children with hypothalamic obesity: Evaluation of possible related factors. Pediatr Pulmonol 2020; 55:3532-3540. [PMID: 32986303 DOI: 10.1002/ppul.25097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Hypothalamic obesity (HO) is a type of obesity that is caused by hypothalamic damage. HO can be complicated by obstructive sleep apnea syndrome (OSAS) due to anatomical narrowing of the upper airway and hypothalamic damage-induced dysfunction of the sleep control mechanisms. We aimed to explore the presence and severity of OSAS in children with HO and hypothesized that OSAS is more severe and frequent in HO than exogenous obesity (EO). METHODS This cross-sectional study was conducted among children aged 6.6-17.9 years. Subjects with HO (n = 14) and controls with EO (n = 19) were consecutively recruited through an endocrinology clinic. All patients underwent full-night polysomnography. The primary outcomes were obstructive apnea-hypopnea index (OAHI) and the severity of OSAS. We analyzed the polysomnography findings, biochemical parameters, Brodsky and modified Mallampati scores, and blood pressure compared with the controls. We explored the different obesity types and these variables in association with OAHI using multiple linear regression (MLR). RESULTS Age and body mass index z scores (BMI-z) were similar between the EO and HO groups. The OAHI of HO (5.8) was higher than that of EO (2.2). In MLR, the predicted OAHI was formulated as an equation using regression coefficients of obesity type (HO), age, and BMI-z (R2 = .41). In the logistic regression analysis, the odds ratio of moderate/severe OSA was 5.6 for HO. CONCLUSIONS Children with HO have a higher risk of moderate/severe OSAS than children with EO. Polysomnography should be considered in all patients with HO.
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Affiliation(s)
- Irem Iyigun
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayfer Alikasifoglu
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nazlı Gonc
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alev Ozon
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mina Hizal
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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15
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Prieto R, Rosdolsky M, Hofecker V, Barrios L, Pascual JM. Craniopharyngioma treatment: an updated summary of important clinicopathological concepts. Expert Rev Endocrinol Metab 2020; 15:261-282. [PMID: 32615875 DOI: 10.1080/17446651.2020.1770081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Craniopharyngiomas (CPs) are benign histological tumors that may develop at different positions along the hypothalamic-pituitary axis. Their close, heterogenous relationship to the hypothalamus makes surgical removal challenging even though this remains the primary treatment strategy. AREAS COVERED This article presents a critical overview of the pathological and clinical concepts regarding CPs that should be considered when planning treatment. Thus, we have performed a comprehensive review of detailed CP reports published between 1839 and 2020. EXPERT OPINION CP surgery should pursue maximal tumor resection while minimizing the risk of injuring the hypothalamus. Therefore, surgical strategies should be individualized for each patient. Accurate assessment of presenting symptoms and preoperative MRI has proven useful to predict the type of CP-hypothalamus relationship that will be found during surgery. CPs with dense and extensive adhesions to the hypothalamus should be highly suspected when MRI shows the hypothalamus positioned around the mid-third of the tumor and an amputated upper portion of the pituitary stalk. Symptoms related to functional impairment of the infundibulo-tuberal area of the third ventricle floor, such as obesity/hyperphagia, Fröhlich's syndrome, diabetes insipidus, and/or somnolence, also indicate risky CP-hypothalamic adhesions. In these cases, limited tumor removal is strongly advocated followed by radiation therapy.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital , Madrid, Spain
| | | | - Verena Hofecker
- Pathologisch-anatomische Sammlung Im Narrenturm - NHM , Vienna, Austria
| | - Laura Barrios
- Statistics Department, Computing Center, CSIC , Madrid, Spain
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital , Madrid, Spain
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16
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Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:1159-1177. [PMID: 32112169 DOI: 10.1007/s00701-020-04265-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. MATERIAL AND METHODS The MEDLINE database was systematically reviewed (January 1970-February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. RESULTS The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied for tumor recurrences. Radiotherapy or intracystic agents are alternative treatments when no further surgery is possible. A multidisciplinary long-term follow-up is necessary.
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17
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Outcome of Endoscopic Endonasal Surgery in Pediatric Craniopharyngiomas. World Neurosurg 2019; 134:e277-e288. [PMID: 31629927 DOI: 10.1016/j.wneu.2019.10.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the last years, few reports have shown the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas in pediatric patients. For these tumors, recent studies have suggested less aggressive surgery, favoring the preservation of the patient's quality of life. OBJECTIVE The aim of this study was to assess the outcome of the EEA in a large series with specific attention on the long-term functional sequelae. MATERIALS All consecutive pediatric craniopharyngiomas operated on through this approach since 2000 were included in the study. Preoperative and postoperative operative clinical, radiologic, and pathologic features were retrieved from patient records (mean follow-up, 72 ± 67 months). RESULTS The series included 25 patients (12 female; mean age, 8.9 ± 4.1 years). Most of the tumors presented with a supradiaphragmatic extension (88%). Removal was radical in 23 patients (92%). Complications consisted of 6 cerebrospinal fluid leaks (24%). One patient (4%) died of postoperative respiratory complications. Most patients (92%) developed panhypopituitarism and visual disturbances normalized or improved in 6 patients (43%). At follow-up, 9 patients (36%) were overweight/obese (6 were already overweight before surgery). The tumor recurrence rate was 19%. CONCLUSIONS EEA can be an effective approach for midline craniopharyngiomas in children older than 3 years. It gives a satisfactory exposure of the suprasellar region and an adequate assessment of the brain-tumor interface. Its main limitations are age-related anatomic features of nasal/paranasal sinuses and the risk of cerebrospinal fluid leak.
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18
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Yang L, Xie SH, Fang C, Zeng EM, Tang B, Hong T. Preservation of Hypothalamic Function with Endoscopic Endonasal Resection of Hypothalamus-Invaded Craniopharyngiomas. World Neurosurg 2019; 132:e841-e851. [PMID: 31398519 DOI: 10.1016/j.wneu.2019.07.225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To analyze the preservation of hypothalamic function using the endoscopic endonasal approach (EEA) in a single-center clinical series of patients with hypothalamus-invaded craniopharyngioma (CP) and compare this series with reported cases by the open transcranial approach (TCA). METHODS A retrospective review of hypothalamus-invaded CP surgical cases treated with EEA was performed. Hypothalamic damage was evaluated in terms of the body mass index (BMI), endocrine status, and quality of life before and after surgery. A review of the available literature reporting the use of EEA and TCA over the last decade was performed for comparison. RESULTS In total, 63 cases amenable to EEA were investigated. The elevation in BMI was substantial and an increase in BMI greater than 9% was observed in 22 patients (34.92%). Most patients exhibited a BMI gain >9% within 3 months postoperatively. A total of 16 of the 19 patients who had normal anterior pituitary function preoperatively worsened after surgery. Of the 27 cases reporting preoperative partial hypopituitarism, 16 cases worsened postoperatively and 11 cases remained unchanged. All 9 cases with preoperative panhypopituitarism remained unchanged postoperatively. A total of 40 new cases developed diabetes insipidus, and 3 of the 10 patients with preoperative diabetes insipidus exhibited resolved at the latest follow-up. The quality of life showed no significant difference. CONCLUSIONS EEA can achieve greater gross total resection than TCA when performed by an experienced surgeon. Combined with the reduced postoperative hypothalamic damage in our patients with only hypothalamus-invaded CP, especially the shortened time horizons of hypothalamic obesity development and reduced percentage of patients with obesity, the EEA technique should be a preferred alternative over TCA.
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Affiliation(s)
- Le Yang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shen Hao Xie
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chao Fang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Er Ming Zeng
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Tang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Hong
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China.
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Akinduro OO, Izzo A, Lu VM, Ricciardi L, Trifiletti D, Peterson JL, Bernet V, Donaldson A, Eggenberger E, Olomu O, Reimer R, Wharen R, Quinones-Hinojosa A, Chaichana KL. Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma: Systematic Review and Meta-Analysis. World Neurosurg 2019; 127:e656-e668. [DOI: 10.1016/j.wneu.2019.03.239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/19/2022]
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20
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Thompson CJ, Costello RW, Crowley RK. Management of hypothalamic disease in patients with craniopharyngioma. Clin Endocrinol (Oxf) 2019; 90:506-516. [PMID: 30614015 DOI: 10.1111/cen.13929] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/21/2022]
Abstract
Patients with craniopharyngioma experience excess morbidity and mortality when compared with the background population and with other hypopituitary patients. Large, suprasellar tumours which form micropapillae into surrounding structures can cause hypothalamic damage before any therapeutic intervention; attempted gross total resection can lead to hypothalamic obesity, sleep disorders, thirst disorders and dysregulation of temperature as well as panhypopituitarism. The management of tumour bulk and the pathophysiology of hypothalamic complications have been reviewed extensively. We present a practical, clinical approach to management of hypothalamic disease in a patient with craniopharyngioma and highlight potential targets for future pharmacological or surgical intervention.
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Affiliation(s)
- Christopher J Thompson
- Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Richard W Costello
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Rachel K Crowley
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
- University College, Dublin, Ireland
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21
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La Corte E, Younus I, Pivari F, Selimi A, Ottenhausen M, Forbes JA, Pisapia DJ, Dobri GA, Anand VK, Schwartz TH. BRAF V600E mutant papillary craniopharyngiomas: a single-institutional case series. Pituitary 2018; 21:571-583. [PMID: 30187175 DOI: 10.1007/s11102-018-0909-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the clinical, radiographic and surgical outcomes in a cohort of patients with BRAF V600E mutant papillary craniopharyngiomas. METHODS A retrospective review was performed to identify all patients with a histological diagnosis of CP operated upon at a single institution between 2005 and 2017. All cases with adequate material were sequenced to confirm the presence of BRAF V600E mutation. RESULTS Sixteen patients were included in the present study. Approach was endoscopic endonasal (EEA) in 14 and transcranial (TCA) in 2. All patients were adult with an average age of 50 years (24-88). Radiographic review demonstrated that the majority (93.7%) were suprasellar and twelve (75%) had third ventricular involvement. No tumor showed evidence of calcifications and 68.7% were mixed solid-cystic. All patients had some evidence of hypopituitarism and 62.5% had hypothalamic disturbances. GTR was achieved in 11/14 (78.6%) EEA and 0/2 (0%) TCA (p < 0.05). The mean length of stay was 17.5 days in the TCA group and 7.6 days in the EEA group (p < 0.05). There were no CSF leaks. Post-operatively, eleven (68.7%) developed new DI or new hypopituitarism. Nine increased their BMI with a mean increase of 12.3%, whereas six patients lost weight with a mean decrease of 5.3%. CONCLUSIONS BRAF V600E mutant papillary tumors represent a clearly distinct clinical-pathological entity of craniopharyngiomas. These are generally non-calcified suprasellar tumors that occur in adults. These distinct characteristics may someday lead to upfront chemotherapy. When surgery is necessary, EEA may be preferred over TCA.
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Affiliation(s)
- Emanuele La Corte
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Health Sciences, University of Milan, Milan, Italy
- Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Iyan Younus
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
| | - Francesca Pivari
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Adelina Selimi
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Malte Ottenhausen
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Neurosurgery, University Mainz, Mainz, Germany
| | - Jonathan A Forbes
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
| | - David J Pisapia
- Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.
- Department of Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
- Department of Otolaryngology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
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