Nisreen Amayiri1, Maisa Swaidan2, Yocoub Yousef3, Hadeel Halalsheh4, Ramiz Abu-Hijlih5, Sima Kalaldeh4, Maha Barbar4,6, Maher Elayyan3, Nesreen Faqih4, Maysa Al-Hussaini7, Mustafa Mehyar3, Ute Bartels8, James Drake9, Awni Musharbash3, Eric Bouffet8. 1. Pediatric Department, King Hussein Cancer Center, 202 Queen, Rania Al-abdullah Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan. namayiri@khcc.jo. 2. Radiology Department, King Hussein Cancer Center, Amman, Jordan. 3. Surgical Department, King Hussein Cancer Center, Amman, Jordan. 4. Pediatric Department, King Hussein Cancer Center, 202 Queen, Rania Al-abdullah Street, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan. 5. Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan. 6. Pediatric Department, Hashemite University, Zarqa, Jordan. 7. Pathology Department, King Hussein Cancer Center, Amman, Jordan. 8. Neuro-oncology, Division of Hematology Oncology, Hospital for Sick Children, Toronto, Canada. 9. Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada.
Abstract
BACKGROUND: Management of craniopharyngioma in children is challenging, and their quality of life can be significantly affected. Series describing this from low-middle income countries (LMIC) are few. PATIENTS AND METHODS: The study provides a retrospective chart review of pediatric patients <18 years old, diagnosed with craniopharyngioma between 2003 and 2014, and treated at King Hussein Cancer Center, Jordan. RESULTS: Twenty-four patients (12 males) were identified. Median age at diagnosis was 7.4 years (0.9-16.4 years). Commonest symptoms were visual impairment and headache (71%). Review of seventeen preoperative MRIs showed hypothalamic involvement in 88% and hydrocephalus in 76%. Thirteen patients (54%) had multiple surgical interventions. Five patients (21%) had initial gross total resection. Eleven patients (46%) received radiotherapy and six (25%) intra-cystic interferon. Five years' survival was 87 ± 7% with a median follow-up of 4.5 years (0.3-12.3 years). Four patients (17%) died; one after post-operative cerebral infarction and three secondary to hypothalamic damage. At their last evaluation, all but one patient required multiple hormonal supplements. Ten patients (42%) had best eye visual acuity (VA) >20/40, and four (16%) were legally blind. Eleven patients (46%) were overweight/obese; one had gastric bypass surgery. Seven patients had hyperlipidemia, and eight developed fatty liver infiltration. Eleven patients (65%) were attending schools and one at college. Nine of the living patients (53%) expressed difficulty to engage in the community. CONCLUSIONS: Management of pediatric craniopharyngioma is particularly complex and demanding in LMIC. Multidisciplinary care is integral to optimize the care and minimize the morbidities. A management outline for LMIC is proposed.
BACKGROUND: Management of craniopharyngioma in children is challenging, and their quality of life can be significantly affected. Series describing this from low-middle income countries (LMIC) are few. PATIENTS AND METHODS: The study provides a retrospective chart review of pediatric patients <18 years old, diagnosed with craniopharyngioma between 2003 and 2014, and treated at King Hussein Cancer Center, Jordan. RESULTS: Twenty-four patients (12 males) were identified. Median age at diagnosis was 7.4 years (0.9-16.4 years). Commonest symptoms were visual impairment and headache (71%). Review of seventeen preoperative MRIs showed hypothalamic involvement in 88% and hydrocephalus in 76%. Thirteen patients (54%) had multiple surgical interventions. Five patients (21%) had initial gross total resection. Eleven patients (46%) received radiotherapy and six (25%) intra-cystic interferon. Five years' survival was 87 ± 7% with a median follow-up of 4.5 years (0.3-12.3 years). Four patients (17%) died; one after post-operative cerebral infarction and three secondary to hypothalamic damage. At their last evaluation, all but one patient required multiple hormonal supplements. Ten patients (42%) had best eye visual acuity (VA) >20/40, and four (16%) were legally blind. Eleven patients (46%) were overweight/obese; one had gastric bypass surgery. Seven patients had hyperlipidemia, and eight developed fatty liver infiltration. Eleven patients (65%) were attending schools and one at college. Nine of the living patients (53%) expressed difficulty to engage in the community. CONCLUSIONS: Management of pediatric craniopharyngioma is particularly complex and demanding in LMIC. Multidisciplinary care is integral to optimize the care and minimize the morbidities. A management outline for LMIC is proposed.
Entities:
Keywords:
Craniopharyngioma; Low middle income country; Multidisciplinary care
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