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Craniopharyngioma surgery

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Abstract

Ideal surgical treatment of craniopharyngiomas remains a major challenge for neurosurgeons. Craniopharyngiomas grow in the deep-seated hypothalamic area that is paramount for vegetative, emotional and endocrine function, and for maintaining worthwhile life. The benign histological nature of craniopharyngiomas belies their biological behavior and the propensity to recur is a major threat. Surgical treatment has to weigh the risk of hypothalamic damage against the risk of tumor recurrence or progression. Both aggressive surgery and conservative minor surgery followed by radiotherapy has been proclaimed by the proponents of different schools. During the past decade, the pendulum has swung back to surgery with the attempt at radical removal. Refined neurosurgical techniques and innovative approaches yielded improved surgical results. The contemporary neurosurgical strategy of treating craniopharyngiomas with early and late outcome data is presented. Neurosurgical therapy is only beneficial in the context of an interdisciplinary treatment concept as discussed here.

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References

  1. Matson DD, Crigler JF (1969) Management of craniopharyngioma in childhood. J Neurosurg 30:377–390

    PubMed  CAS  Google Scholar 

  2. Katz E (1975) Late results of radical excision of craniopharyngiomas in children. J Neurosurg 42:86–90

    PubMed  CAS  Google Scholar 

  3. Fischer EG, Welch K, Belli JA et al (1985) Treatment of craniopharyngiomas in children: 1972–1981. J Neurosurg 62:496–501

    PubMed  CAS  Google Scholar 

  4. Hetelekidis S, Barnes PD, Tao ML et al (1993) 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys 27:189–195

    PubMed  CAS  Google Scholar 

  5. Rajan B, Ashley S, Gorman C et al (1993) Craniopharyngioma—long-term results following limited surgery and radiotherapy. Radiother Oncol 26:1–10. doi:10.1016/0167-8140(93)90019-5

    Article  PubMed  CAS  Google Scholar 

  6. Di Rocco C, Caldarelli M, Tamburrini G, Massimi L (2006) Surgical management of craniopharyngiomas—experience with a pediatric series. J Pediatr Endocrinol Metab 19:355–366

    PubMed  Google Scholar 

  7. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250

    PubMed  CAS  Google Scholar 

  8. Samii M, Tatagiba M (2000) Surgery of craniopharyngiomas. In: Kaye AH, Black PM (eds) Operative neurosurgery. Churchill Livinstone, London, pp 741–749

    Google Scholar 

  9. Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3–11

    PubMed  Google Scholar 

  10. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89:547–551

    PubMed  CAS  Google Scholar 

  11. Baskin D, Wilson CB (1986) Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg 65:22–27

    PubMed  CAS  Google Scholar 

  12. De Vile CJ, Grant DB, Kendall BE et al (1996) Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J Neurosurg 85:73–81

    PubMed  Google Scholar 

  13. Müller HL, Faldum A, Etavard-Gorris N et al (2003) Functional capacity, obesity and hypothalamic involvement: cross-sectional study on 212 patients with childhood craniopharyngioma. Klin Padiatr 215:310–314. doi:10.1055/s-2003-45499

    Article  PubMed  Google Scholar 

  14. König A, Lüdecke DK, Herrmann HD (1986) Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir (Wien) 83:1–7. doi:10.1007/BF01420500

    Article  Google Scholar 

  15. Laws ER (1980) Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661–666

    PubMed  Google Scholar 

  16. Honegger J, Buchfelder M, Fahlbusch R, Däubler B, Dörr H (1992) Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37:189–196. doi:10.1016/0090-3019(92)90229-G

    Article  PubMed  CAS  Google Scholar 

  17. Chakrabarti I, Amar AP, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102:650–657

    PubMed  Google Scholar 

  18. Maira G, Anile C, Rossi GF, Colosimo C (1995) Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 36:715–724. doi:10.1097/00006123-199504000-00012

    Article  PubMed  CAS  Google Scholar 

  19. Kaptain GJ, Vincent DA, Sheehan JP, Laws ER (2001) Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49:94–101. doi:10.1097/00006123-200107000-00014

    Article  PubMed  CAS  Google Scholar 

  20. Maira G, Anile C, Albanese A, Cabezas D, Pardi F, Vignati A (2004) The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg 100:445–451

    PubMed  Google Scholar 

  21. Weiss MH (1987) Transnasal transsphenoidal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 476–494

    Google Scholar 

  22. Kato T, Sawamura Y, Abe H, Nagashima M (1998) Transsphenoidal–transtuberculum sellae approach for supradiaphragmatic tumors: technical note. Acta Neurochir (Wien) 140:715–719. doi:10.1007/s007010050167

    Article  CAS  Google Scholar 

  23. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–550. doi:10.1227/01.NEU.0000134287.19377.A2

    Article  PubMed  Google Scholar 

  24. Dusick JR, Esposito F, Kelly DF et al (2005) The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 102:832–841

    PubMed  Google Scholar 

  25. De Divitiis E, Cavallo LM, Cappabianca P, Esposito F (2007) Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 60:46–59. doi:10.1227/01.NEU.0000249211.89096.25

    Article  PubMed  Google Scholar 

  26. Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. J Neurosurg 92:1028–1035

    PubMed  CAS  Google Scholar 

  27. Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51

    Article  PubMed  CAS  Google Scholar 

  28. Cappabianca P, Cavallo LM, Colao AM, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298

    PubMed  Google Scholar 

  29. Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F (2006) The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59(ONS Suppl 1):75–83

    Google Scholar 

  30. Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106:400–406. doi:10.3171/jns.2007.106.3.400

    Article  PubMed  Google Scholar 

  31. Shi X, Wu B, Zhou Z, Fan T, Zhang Y (2006) Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin Med J (Engl) 119:1653–1663

    Google Scholar 

  32. Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. J Neurosurg 73:3–11

    PubMed  CAS  Google Scholar 

  33. Steno J, Malacek M, Bizik I (2004) Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 54:1051–1060

    PubMed  Google Scholar 

  34. Weiner HL, Wisoff JH, Rosenberg ME et al (1994) Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 35:1001–1011. doi:10.1097/00006123-199412000-00001

    Article  PubMed  CAS  Google Scholar 

  35. Sweet WH (1976) Radical surgical treatment of craniopharyngioma. Clin Neurosurg 23:52–79

    PubMed  CAS  Google Scholar 

  36. Patterson RH, Danylevich A (1980) Surgical removal of craniopharyngiomas by a transcranial approach through the lamina terminalis and sphenoid sinus. Neurosurgery 7:111–117. doi:10.1097/00006123-198008000-00001

    Article  PubMed  Google Scholar 

  37. Karavitaki N, Brufani C, Warnert JT et al (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 62:397–409. doi:10.1111/j.1365-2265.2005.02231.x

    Article  CAS  Google Scholar 

  38. Duff JM, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46:291–305. doi:10.1097/00006123-200002000-00007

    Article  Google Scholar 

  39. Regine WF, Kramer S (1992) Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys 24:611–617

    PubMed  CAS  Google Scholar 

  40. Pierre-Kahn A, Recassens C, Pinto G et al (2005) Social and psycho-intellectual outcome following radical removal of craniopharyngiomas in childhood. Childs Nerv Syst 21:817–824. doi:10.1007/s00381-005-1205-6

    Article  PubMed  CAS  Google Scholar 

  41. Honegger J, Buchfelder M, Fahlbusch R (1999) Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg 90:251–257

    PubMed  CAS  Google Scholar 

  42. Hoffmann HJ, De Silva M, Humphreys RP, Drake JM, Smith ML, Blaser SI (1992) Aggressive surgical management of craniopharyngiomas in children. J Neurosurg 76:47–52

    Google Scholar 

  43. Nimsky C, Ganslandt O, Hofmann B, Fahlbusch R (2003) Limited benefit of intraoperative low-field magnetic resonance imaging in craniopharyngioma surgery. Neurosurgery 53:72–81. doi:10.1227/01.NEU.0000068728.08237.AF

    Article  PubMed  Google Scholar 

  44. Symon L, Pell MF, Habib AH (1991) Radical excision of craniopharyngioma by the temporal route: a review of 50 patients. Br J Neurosurg 5:539–549. doi:10.3109/02688699109002877

    Article  PubMed  CAS  Google Scholar 

  45. Sorva R, Heiskanen O (1986) Craniopharyngioma in Finland: a study of 123 cases. Acta Neurochir (Wien) 81:85–89. doi:10.1007/BF01401226

    Article  CAS  Google Scholar 

  46. Adamson TE, Wiestler OD, Kleihues P, Yasargil MG (1990) Correlation of clinical and pathological features in surgically treated craniopharyngiomas. J Neurosurg 73:12–17

    PubMed  CAS  Google Scholar 

  47. Manaka S, Teramoto A, Takakura K (1985) The efficacy of radiotherapy for craniopharyngioma. J Neurosurg 62:648–656

    PubMed  CAS  Google Scholar 

  48. Carpentieri SC, Waber DP, Scott RM et al (2001) Memory deficits among children with craniopharyngiomas. Neurosurgery 49:1053–1058. doi:10.1097/00006123-200111000-00005

    Article  PubMed  CAS  Google Scholar 

  49. Cavazzuti V, Fischer EG, Welch K, Belli JA, Winston KR (1983) Neurological and psychophysiological sequelae following different treatments of craniopharyngioma in children. J Neurosurg 59:409–417

    PubMed  CAS  Google Scholar 

  50. Dekkers OM, Biermasz NR, Smit JWA et al (2006) Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154:483–489. doi:10.1530/eje.1.02114

    Article  PubMed  CAS  Google Scholar 

  51. Honegger J, Barocka A, Sadri B, Fahlbusch R (1998) Neuropsychological results of craniopharyngioma surgery in adults: a prospective study. Surg Neurol 50:19–29. doi:10.1016/S0090-3019(97)00507-7

    Article  PubMed  CAS  Google Scholar 

  52. Riva D, Pantaleoni C, Devoti M, Saletti V, Nichelli F, Giorgi C (1998) Late neuropsychological and behavioural outcome of children surgically treated for craniopharyngioma. Childs Nerv Syst 14:179–184. doi:10.1007/s003810050207

    Article  PubMed  CAS  Google Scholar 

  53. Pollock BE, Lunsford LD, Kondziolka D, Levine G, Flickinger JC (1995) Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys 33:437–446. doi:10.1016/0360-3016(95)00175-X

    PubMed  CAS  Google Scholar 

  54. Varlotto JM, Flickinger JC, Kondziolka D, Lunsford LD, Deutsch M (2002) External beam irridiation of craniopharyngiomas: long-term analysis of tumor control and morbidity. Int J Radiat Oncol Biol Phys 54:492–499. doi:10.1016/S0360-3016(02)02965-6

    PubMed  Google Scholar 

  55. Voges J, Sturm V, Lehrke R, Treuer H, Gauss C, Berthold F (1997) Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal ß-emitting radioactive sources. Neurosurgery 40:263–270. doi:10.1097/00006123-199702000-00006

    Article  PubMed  CAS  Google Scholar 

  56. Van den Berge JH, Blaauw G, Breeman WAP, Rahmy A, Wijngaarde R (1992) Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 77:545–550

    PubMed  Google Scholar 

  57. Minniti G, Saran F, Traish D et al (2007) Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas. Radiother Oncol 82:90–95. doi:10.1016/j.radonc.2006.11.005

    Article  PubMed  Google Scholar 

  58. Schulz-Ertner D, Frank C, Herfarth KK, Rhein B, Wannenmacher M, Debus J (2002) Fractionated stereotactic radiotherapy for craniopharyngiomas. Int J Radiat Oncol Biol Phys 54:1114–1120. doi:10.1016/S0360-3016(02)03029-8

    Article  PubMed  Google Scholar 

  59. Combs SE, Thilmann C, Huber PE, Hoess A, Debus J, Schulz-Ertner D (2007) Achievement of long-term local control in patients with craniopharyngiomas using high precision stereotactic radiotherapy. Cancer 109:2308–2314. doi:10.1002/cncr.22703

    Article  PubMed  Google Scholar 

  60. Merchant TE, Kiehna EN, Kun LE, Mulhern RK, Li C, Xiong X, Boop FA, Sanford RA (2006) Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function. J Neurosurg 104(2 Suppl Pediatrics):94–102

    PubMed  Google Scholar 

  61. Backlund EO, Axelsson B, Bergstrand CG et al (1989) Treatment of craniopharyngiomas—the stereotactic approach in a ten to 23 years’ perspective. I. Surgical, radiological and ophthalmological aspects. Acta Neurochir (Wien) 99:11–19. doi:10.1007/BF01407771

    Article  CAS  Google Scholar 

  62. Chiou SM, Lunsford LD, Niranjan A, Kondziolka D, Flickinger JC (2001) Stereotactic radiosurgery of residual or recurrent craniopharyngioma, after surgery, with or without radiation therapy. Neuro Oncol 3:159–166. doi:10.1215/15228517-3-3-159

    Article  PubMed  CAS  Google Scholar 

  63. Suh JH, Gupta N (2006) Role of radiation therapy and radiosurgery in the management of craniopharyngiomas. Neurosurg Clin N Am 17:143–148. doi:10.1016/j.nec.2006.02.001

    Article  PubMed  Google Scholar 

  64. Kobayashi T, Kida Y, Mori Y, Hasegawa T (2005) Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg 103(6 Suppl Pediatrics):482–488

    PubMed  Google Scholar 

  65. Hukin J, Steinbok P, Lafay-Cousin L et al (2007) Intracystic bleomycin therapy for craniopharyngioma in children. Cancer 109:2124–2131. doi:10.1002/cncr.22633

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Jürgen Honegger & Marcos Tatagiba

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  1. Jürgen Honegger
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  2. Marcos Tatagiba
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Correspondence to Jürgen Honegger.

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Honegger, J., Tatagiba, M. Craniopharyngioma surgery. Pituitary 11, 361–373 (2008). https://doi.org/10.1007/s11102-008-0137-z

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