Advances in the treatment of Adamantinomatous craniopharyngioma: How to balance tumor control and quality of life in the current environment: a narrative review

Tumor features in adult papillary and adamantinomatous craniopharyngioma: neuroradiological evaluation of pituitary-hypothalamic-axis dysfunction and outcome prediction

PURPOSE

To identify radiological features distinguishing adamantinomatous craniopharyngioma (ACP) from papillary craniopharyngioma (PCP) and assess their impact on pituitary-hypothalamic-axis dysfunction and post-surgery recurrence.

METHODS

MRIs of 80 patients (48 with ACP, 32 with PCP) were analyzed for tumor topography, size, cystic-solid composition, peritumoral edema, signal intensity, and CT for calcification patterns. Volumes, normalized signal intensity minimum (nT2min) and maximum (nT1Max) values were measured from T2 and T1-weighted images, respectively. These variables were correlated with pituitary-hypothalamic-axis dysfunction and surgical outcomes.

RESULTS

There were no significant topographic differences between ACP and PCP (P > 0.85). ACP tumors had larger volumes (4992.2 ± 5195.5 mm³ vs. 814.4 ± 1023 mm³), a predominant cystic component, lower nT2min values (42.57% vs. 55.55%), higher nT1Max values (273.25% vs. 216.67%), and more peripheral calcifications (P < 0.001). In ACP lower nT2min and higher nT1Max values correlated with incomplete surgical excision (nT2min: P < 0.001, r = -0.607; nT1Max: P < 0.001, r = 0.817) while only lower nT2min values correlated with higher recurrence likelihood (nT2min: P < 0.001, r = -0.485). Regardless of histotype, tumors invading the third ventricle floor were more likely to show peritumoral edema (P < 0.001), hypothalamic infiltration (P < 0.001), and dysfunction (P = 0.013).

CONCLUSION

Tumor location relative to the third ventricle and associated parenchymal changes are independent predictors of hypothalamic dysfunction, regardless of tumor histotype. ACP's cystic composition characterized by a higher concentration of thick or proteinaceous material and peripheral calcifications predict poorer surgical outcomes.

Neuroendoscopic surgery for acute presentation of cystic craniopharyngiomas

Acute presentation of cystic craniopharyngioma is a potentially life-threatening condition, characterized by disability and increased mortality risk, often caused by large cysts with or without hydrocephalus. This study evaluated the applicability of minimally invasive neuroendoscopic surgery (NES) for rapid intracranial pressure relief and tumor control as an alternative to emergent microsurgical resection. A retrospective review of the electronic medical record database of patients with craniopharyngiomas treated at our institution between June 2007 and October 2024 identified 13 non-consecutive cases of acute presentation of cystic craniopharyngioma managed with NES. Interventions included pellucid septostomy (n = 2), ventriculoperitoneal shunt surgery (n = 2), and Ommaya reservoir placement (n = 6). Clinical and radiological data were analyzed to assess treatment outcomes. The most common acute symptoms were severe headache (69.2%), frequent vomiting (53.8%), sudden onset of consciousness disturbance (38.5%), visual impairment (46.2%), gait instability (23.1%), and cognitive dysfunction (15.4%). Ten patients had hydrocephalus at admission. All patients experienced symptom relief following NES, with no procedure-related mortality or complications. Hydrocephalus resolved in all cases, and subjective visual function improved in 83.3% of patients postoperatively. Endocrine function remained stable. At a median follow-up of 62 months (range, 38-130), local tumor control was achieved in 8 patients (61.5%) without requiring adjuvant therapy. NES is a safe, effective approach for managing acute presentation of cystic craniopharyngioma, particularly in patients with hydrocephalus. It offers rapid symptom relief and tumor control and is a potential staging treatment in selected cases.

Pediatric Suprasellar Tumors: Unveiling the Mysteries of Craniopharyngioma and Germ Cell Tumors-Insights From Diagnosis to Advanced Therapeutics

BACKGROUND

Pediatric suprasellar tumors represent a unique and intricate challenge in the landscape of pediatric neuro-oncology.

METHODS

We conducted an in-depth literature review, focusing on large clinical trials and major publications in pediatric suprasellar tumors, particularly craniopharyngiomas and germ cell tumors, to provide a comprehensive perspective on the challenges in the diagnosis, treatment, and molecular aspects of these tumors.

RESULTS

Nestled within the critical confines of the suprasellar region, these tumors manifest against the backdrop of crucial growth and developmental processes. The suprasellar region, housing the pituitary gland and surrounding structures, plays a pivotal role in orchestrating hormonal regulation and growth. The emergence of tumors within this delicate terrain introduces a complex array of challenges, encompassing neurological, endocrinological, and developmental dimensions from damage to the hypothalamic-pituitary axis.

CONCLUSIONS

This article provides a thorough exploration of pediatric craniopharyngiomas and germ cell tumors, elucidating their clinical presentations, treatment modalities, and outcomes. The focused analysis aims to deepen our understanding of these tumors by offering insights for refined clinical management and improved patient outcomes.

Impact of stereotactic radiotherapy for craniopharyngioma: a large, academic hospital cohort

PURPOSE

Adjuvant radiotherapy has been a standard of care for craniopharyngioma. Nevertheless, it is a rare disease with multiple presentations, and results with conservative surgery followed by radiotherapy (RT) can vary. We compared treatment results for both adult and pediatric patients.

METHODS

This is a retrospective cohort of patients treated between 2010 and 2023 in a single university hospital.

RESULTS

Seventy-nine patients' clinical data was assessed. Median follow-up was 75.5 months (7.1-210.2 months). Median age was 24.4 years, and 40 (50.6%) were considered pediatric patients. Median lesion size after surgery was 3.4 cm (range 0.4 to 10.4 cm). Ten patients (16.9%) were submitted to Ommaya reservoir placement surgery, and most (70%) have lesion reductions that impact radiotherapy planning. Timing of radiotherapy whether adjuvant or salvage did not impact progression-free survival (PFS) (p = 0.39). Median PFS was not reached, and mean PFS was 65.7 months. Disease control was obtained in 67 (84.1%) patients.

CONCLUSION

We achieved great results with consisting institutional protocol in both adult and childhood craniopharyngioma. Timing of RT did not translate into loss of disease control in our study, with good results for salvage radiotherapy. Ommaya reservoirs can impact RT planning, but not outcomes.

Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma

Adamantinomatous craniopharyngioma (ACP) is one of the two types of craniopharyngioma recognized by the World Health Organization (WHO), the other being papillary craniopharyngioma (PCP). These rare, benign tumours of the pituitary region are classified as Grade 1 central nervous system (CNS) tumours. ACP predominantly affects adolescents aged 5-15 years and adults over 50 years. It is usually located in the sellar and suprasellar regions. We present the case of an 18-year-old Malaysian female with a six-year history of persistent epistaxis and progressive nasal obstruction, an atypical presentation of ACP. This report highlights an entirely ectopic location of ACP in the sinonasal region. The tumour encompassed the left nasal cavity, the left anterior and posterior ethmoid sinuses, and the bilateral frontal sinuses. The unusual presentation of this tumour was detected with the aid of CT and MRI and confirmed by histopathological examination. In this case report, we discuss a rare presentation, an unusual location, and the strategies employed to overcome these challenges.