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Background: There is limited literature on outcomes after surgical treatment of giant craniopharyngiomas in adult and pediatric patients.
Methods: A retrospective review of 159 patients undergoing surgery for craniopharyngiomas at a single institution was performed. Patients with giant craniopharyngiomas (maximum dimension ≥4.5 cm) were compared with nongiant tumors in terms of various clinical and radiological parameters and long-term surgical outcomes. Extent of resection was determined by postoperative magnetic resonance imaging. Factors associated with post-treatment obesity were also analyzed.
Results: Giant craniopharyngiomas (n = 66) were characterized by higher rates of childhood presentation, visual impairment, neurological deficits, multicompartmental involvement, and hydrocephalus as compared with nongiant tumors (n = 139). Giant tumors also were less likely to undergo transsphenoidal resection and were associated with a higher rate of postoperative neurological morbidity. There were no significant differences between the 2 groups in terms of extent of resection, use of postoperative radiation therapy, and long-term endocrinological outcomes. Overall recurrence rates over a mean follow-up period of 4.1 years were similar between giant and nongiant tumors; however, recurrences after presumed gross total resection/near total resection were significantly higher in the former subgroup versus the latter (39.4% vs. 18.4%; P = 0.044). Risk factors for post-treatment obesity in giant craniopharyngiomas included adult age (P = 0.001), preoperative obesity (P = 0.003), and hypothalamic involvement (P = 0.012).
Conclusion: Gross total resection/near total resection of giant craniopharyngiomas can be achieved at rates comparable to nongiant tumors. However, there remains a greater risk of postoperative neurological morbidity. Radiation therapy mitigates the risk of recurrence on long-term follow-up.
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http://dx.doi.org/10.1016/j.wneu.2022.03.073 | DOI Listing |
J Clin Neurosci
December 2024
Head Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India.
This case highlights the surgical steps and nuances in preserving the pituitary stalk to ensure good endocrinological outcomes during endoscopic craniopharyngioma resection.
View Article and Find Full Text PDFJ Neurosurg Pediatr
December 2024
Departments of2Radiation Oncology and.
World Neurosurg
December 2024
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address:
J Craniofac Surg
October 2024
Department of Neurosurgery, Yangtze River Shipping General Hospital/Wuhan Brain Hospital, Wuhan, Hubei, China.
Objective: In children with giant cystic solid craniopharyngioma (CP), the Ommaya reservoir was implanted in the CP cavity, and the cystic fluid was continuously drained for 5 days before the tumor resection.
Methods: An 11-year-old male patient was admitted to the hospital due to vision loss for 1 year, intermittent headache, vomiting for 6 months, and frequent urination for 2 months. Besides, magnetic resonance imaging of the head showed cystic solid lesions in the sellar region, suprasellar, and bilateral frontal lobes, with a size of 96.
Oper Neurosurg (Hagerstown)
May 2024
Department of Neurosurgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Background And Objectives: Giant pediatric craniopharyngiomas are rare tumors whose clinical and surgical management is extremely challenging. A variety of open transcranial approaches has been used to resect these lesions. Although there has been an increasing acceptance of the endoscopic endonasal approach (EEA) for the resection of pediatric craniopharyngiomas in recent years, many surgeons continue to recommend against the use of the EEA for giant pediatric craniopharyngiomas.
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