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Treatment strategies in childhood craniopharyngioma.

Puget S - Front Endocrinol (Lausanne) (2012)

Bottom Line: With this in mind, risk-adapted strategies designed to preserve hypothalamic structures have been developed.The preliminary results of these strategies appear to be encouraging.However, the long-term clinical outcome in terms of post irradiation complications and management of relapses is currently unknown.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurosurgery, Necker Hospital, Université Paris Descartes Paris, France.

ABSTRACT
The surgical management of craniopharyngiomas in children remains one of the more controversial topics in pediatric neurosurgery. Theoretically, the benign histology implies that total surgical excision would be sufficient to provide a cure. It has been widely established however, that in certain cases total excision may lead to unacceptable hypothalamic injury. The therapeutic goals for pediatric craniopharyngiomas therefore, require not just cure of the disease but also preservation of function. Over the last 15 years, there has been a growing worldwide advocacy for less extensive resection and for the utilization of multimodality therapy to limit morbidity. With this in mind, risk-adapted strategies designed to preserve hypothalamic structures have been developed. The preliminary results of these strategies appear to be encouraging. However, the long-term clinical outcome in terms of post irradiation complications and management of relapses is currently unknown.

No MeSH data available.


Related in: MedlinePlus

Surgical strategy grade 2 pre-op. (A) At referral, the patient had severe intracranial hypertension secondary to obstructive hydrocephalus from a large intraventricular cyst of the third ventricle. An Ommaya reservoir was placed within the cyst as a matter of urgency. The tumor clearly invaded the hypothalamus (Type 2 pre-op) therefore the goal of surgery was to perform a subtotal removal leaving that component. (B) The residual lesion, attached to the infundibulum, which could not safely be removed.
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Figure 4: Surgical strategy grade 2 pre-op. (A) At referral, the patient had severe intracranial hypertension secondary to obstructive hydrocephalus from a large intraventricular cyst of the third ventricle. An Ommaya reservoir was placed within the cyst as a matter of urgency. The tumor clearly invaded the hypothalamus (Type 2 pre-op) therefore the goal of surgery was to perform a subtotal removal leaving that component. (B) The residual lesion, attached to the infundibulum, which could not safely be removed.

Mentions: The likelihood of hypothalamic damage may be predicted by the degree of pre-operative hypothalamic involvement and surgical skill (Sanford, 1994; Boop, 2007; Puget et al., 2007). Treatment strategies should therefore be adapted to the degree of pre-operative hypothalamic involvement, MRI type 0, 1, and 2, in order to minimize morbidity. For those where the craniopharyngioma does not involve the hypothalamus (type 0 pre-op), total resection is suitable (Figure 3); when the tumor compresses the hypothalamus (type 1 pre-op), total resection may still be the best solution. However, the outcome will depend on the surgeon’s skill in this domain. Finally, when the tumor involves the hypothalamus (type 2 pre-op), subtotal resection with respect to the involved hypothalamus combined with local irradiation currently appears to be the better option (Figure 4).


Treatment strategies in childhood craniopharyngioma.

Puget S - Front Endocrinol (Lausanne) (2012)

Surgical strategy grade 2 pre-op. (A) At referral, the patient had severe intracranial hypertension secondary to obstructive hydrocephalus from a large intraventricular cyst of the third ventricle. An Ommaya reservoir was placed within the cyst as a matter of urgency. The tumor clearly invaded the hypothalamus (Type 2 pre-op) therefore the goal of surgery was to perform a subtotal removal leaving that component. (B) The residual lesion, attached to the infundibulum, which could not safely be removed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367313&req=5

Figure 4: Surgical strategy grade 2 pre-op. (A) At referral, the patient had severe intracranial hypertension secondary to obstructive hydrocephalus from a large intraventricular cyst of the third ventricle. An Ommaya reservoir was placed within the cyst as a matter of urgency. The tumor clearly invaded the hypothalamus (Type 2 pre-op) therefore the goal of surgery was to perform a subtotal removal leaving that component. (B) The residual lesion, attached to the infundibulum, which could not safely be removed.
Mentions: The likelihood of hypothalamic damage may be predicted by the degree of pre-operative hypothalamic involvement and surgical skill (Sanford, 1994; Boop, 2007; Puget et al., 2007). Treatment strategies should therefore be adapted to the degree of pre-operative hypothalamic involvement, MRI type 0, 1, and 2, in order to minimize morbidity. For those where the craniopharyngioma does not involve the hypothalamus (type 0 pre-op), total resection is suitable (Figure 3); when the tumor compresses the hypothalamus (type 1 pre-op), total resection may still be the best solution. However, the outcome will depend on the surgeon’s skill in this domain. Finally, when the tumor involves the hypothalamus (type 2 pre-op), subtotal resection with respect to the involved hypothalamus combined with local irradiation currently appears to be the better option (Figure 4).

Bottom Line: With this in mind, risk-adapted strategies designed to preserve hypothalamic structures have been developed.The preliminary results of these strategies appear to be encouraging.However, the long-term clinical outcome in terms of post irradiation complications and management of relapses is currently unknown.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurosurgery, Necker Hospital, Université Paris Descartes Paris, France.

ABSTRACT
The surgical management of craniopharyngiomas in children remains one of the more controversial topics in pediatric neurosurgery. Theoretically, the benign histology implies that total surgical excision would be sufficient to provide a cure. It has been widely established however, that in certain cases total excision may lead to unacceptable hypothalamic injury. The therapeutic goals for pediatric craniopharyngiomas therefore, require not just cure of the disease but also preservation of function. Over the last 15 years, there has been a growing worldwide advocacy for less extensive resection and for the utilization of multimodality therapy to limit morbidity. With this in mind, risk-adapted strategies designed to preserve hypothalamic structures have been developed. The preliminary results of these strategies appear to be encouraging. However, the long-term clinical outcome in terms of post irradiation complications and management of relapses is currently unknown.

No MeSH data available.


Related in: MedlinePlus