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Calandrelli R, Pilato F, D'Apolito G, Grimaldi A, Chiloiro S, Gessi M, Giampietro A, Bianchi A, Valeri F, Doglietto F, Lauretti L, Gaudino S. Tumor features in adult papillary and adamantinomatous craniopharyngioma: neuroradiological evaluation of pituitary-hypothalamic-axis dysfunction and outcome prediction. Neuroradiology 2025; 67:1313-1327. [PMID: 40293470 DOI: 10.1007/s00234-025-03615-z] [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: 02/09/2024] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
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.
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Affiliation(s)
- Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy.
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Gabriella D'Apolito
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Alessandro Grimaldi
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Sabrina Chiloiro
- Department of Endocrinology, Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Marco Gessi
- Department of Woman and Child Health Sciences and Public Health, Anatomic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Antonella Giampietro
- Department of Endocrinology, Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Antonio Bianchi
- Department of Endocrinology, Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Federico Valeri
- Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Francesco Doglietto
- Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Liverana Lauretti
- Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Simona Gaudino
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy
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Chen A, Li J, Chen X, Wang F, Ai M, Yao X, Sun T, Zhou R. Neuroendoscopic surgery for acute presentation of cystic craniopharyngiomas. Neurosurg Rev 2025; 48:64. [PMID: 39828797 DOI: 10.1007/s10143-025-03228-3] [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: 12/08/2024] [Revised: 01/11/2025] [Accepted: 01/15/2025] [Indexed: 01/22/2025]
Abstract
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.
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Affiliation(s)
- Ao Chen
- Department of Neurosurgery, YueYang People's Hospital, Yueyang, Hunan, China
| | - Jianxian Li
- Department of Neurosurgery, YueYang People's Hospital, Yueyang, Hunan, China
| | - Xun Chen
- Department of Neurosurgery, Changsha Fourth People's Hospital, Changsha, China
| | - Fei Wang
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - MingDa Ai
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaoyan Yao
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tao Sun
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - RenHui Zhou
- Department of Neurosurgery, YueYang People's Hospital, Yueyang, Hunan, China.
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Shatara M, Abdelbaki MS. Pediatric Suprasellar Tumors: Unveiling the Mysteries of Craniopharyngioma and Germ Cell Tumors-Insights From Diagnosis to Advanced Therapeutics. Pediatr Neurol 2025; 162:55-68. [PMID: 39561686 DOI: 10.1016/j.pediatrneurol.2024.10.016] [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: 01/21/2024] [Revised: 08/07/2024] [Accepted: 10/23/2024] [Indexed: 11/21/2024]
Abstract
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.
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Affiliation(s)
- Margaret Shatara
- Department of Pediatric Hematology and Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
| | - Mohamed S Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
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Mauro GP, Da Róz LM, Gico VDC, Weltman E, de Souza EC, Villar RC, Matushita H, Carlotti CG. Impact of stereotactic radiotherapy for craniopharyngioma: a large, academic hospital cohort. Childs Nerv Syst 2024; 41:11. [PMID: 39607561 DOI: 10.1007/s00381-024-06686-0] [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: 09/20/2024] [Accepted: 10/24/2024] [Indexed: 11/29/2024]
Abstract
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.
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Affiliation(s)
- Geovanne Pedro Mauro
- Department of Radiology and Oncology - Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Leila Maria Da Róz
- Department of Neurology - Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vinicius de Carvalho Gico
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Medical School of Sao Paulo University, São Paulo, Brazil
| | - Eduardo Weltman
- Department of Radiology and Oncology - Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Evandro César de Souza
- Department of Neurology - Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosangela Correa Villar
- Department of Radiology and Oncology - Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Hamilton Matushita
- Department of Neurology - Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos Gilberto Carlotti
- Department of Neurology - Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Selva Kumaran K, Shamsudin NS, Dalip Singh HS, Devesahayam PR. Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma. Cureus 2024; 16:e68357. [PMID: 39355486 PMCID: PMC11443304 DOI: 10.7759/cureus.68357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 10/03/2024] Open
Abstract
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.
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