Caroline Apra1, Ciprian Enachescu2, Veronique Lapras3, Gerald Raverot4, Emmanuel Jouanneau5. 1. Skull Base and Pituitary Surgical Department, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon; Sorbonne Université, Université Pierre et Marie Curie, Paris, France; Brain and Spine Institute, Inserm U1127, CNRS UMR7225, Paris, France. Electronic address: caroline.apra@neurochirurgie.fr. 2. Radiotherapy Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France. 3. Radiological Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France. 4. Endocrine Department, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1052, CNRS UMR5286, Lyon I University, Signaling, Metabolism and Tumor Progression, Cancer Center of Lyon, Lyon, France; University of Lyon, Université Claude Bernard, Lyon, France. 5. Skull Base and Pituitary Surgical Department, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon; Inserm U1052, CNRS UMR5286, Lyon I University, Signaling, Metabolism and Tumor Progression, Cancer Center of Lyon, Lyon, France; University of Lyon, Université Claude Bernard, Lyon, France.
Abstract
OBJECTIVE: The treatment of hypothalamus-invading craniopharyngiomas, based on pediatric experience, is subtotal resection (STR) with radiotherapy. This strategy sometimes leads to uncontrollable tumor progression. In adults, with the use of endoscopic endonasal surgery (EES), does removing the hypothalamic part of the tumor-whenever possible-compromise the outcome of the patients? METHODS: We included adults with craniopharyngioma treated by a first EES in 2008-2016 by senior neurosurgeon (E.J.). Endocrine, ophthalmologic, and hypothalamic data were retrospectively collected, including body mass index (BMI), cognitive and social status, with a systematic follow-up interview. Magnetic resonance imaging scans were graded according to Puget classification: 0, no hypothalamic involvement; 1, hypothalamic displacement; and 2, hypothalamic involvement. Grade 2 tumors were separated into gross total resection (GTR) or STR. RESULTS: We included 22 patients aged 18-79 years. Presenting symptoms were visual (14, 64%), endocrine dysfunction (10, 45%), BMI >30 (8, 36%), and cognitive/psychiatric impairment (9, 41%). Fourteen (64%) were grade 2 craniopharyngiomas. GTR was performed in 14 (64%) patients. Postoperatively, 12/14 (86%) cases improved visually, and 20 (91%) needed hormone replacement therapy. There was no difference in BMI evolution in the GTR versus STR group, cognitive status was stable or improved in all patients except 1; 4/8 patients with STR experienced progression needing adjuvant treatment versus no patient with GTR. CONCLUSIONS: EES GTR of grade 2 craniopharyngiomas does not cause major hypothalamic worsening, in contrast with children operated by cranial approaches. The surgeon's experience is key in deciding when to stop the dissection. Offering GTR whenever possible aims at avoiding tumor progression and radiotherapy.
OBJECTIVE: The treatment of hypothalamus-invading craniopharyngiomas, based on pediatric experience, is subtotal resection (STR) with radiotherapy. This strategy sometimes leads to uncontrollable tumor progression. In adults, with the use of endoscopic endonasal surgery (EES), does removing the hypothalamic part of the tumor-whenever possible-compromise the outcome of the patients? METHODS: We included adults with craniopharyngioma treated by a first EES in 2008-2016 by senior neurosurgeon (E.J.). Endocrine, ophthalmologic, and hypothalamic data were retrospectively collected, including body mass index (BMI), cognitive and social status, with a systematic follow-up interview. Magnetic resonance imaging scans were graded according to Puget classification: 0, no hypothalamic involvement; 1, hypothalamic displacement; and 2, hypothalamic involvement. Grade 2 tumors were separated into gross total resection (GTR) or STR. RESULTS: We included 22 patients aged 18-79 years. Presenting symptoms were visual (14, 64%), endocrine dysfunction (10, 45%), BMI >30 (8, 36%), and cognitive/psychiatric impairment (9, 41%). Fourteen (64%) were grade 2 craniopharyngiomas. GTR was performed in 14 (64%) patients. Postoperatively, 12/14 (86%) cases improved visually, and 20 (91%) needed hormone replacement therapy. There was no difference in BMI evolution in the GTR versus STR group, cognitive status was stable or improved in all patients except 1; 4/8 patients with STR experienced progression needing adjuvant treatment versus no patient with GTR. CONCLUSIONS:EESGTR of grade 2 craniopharyngiomas does not cause major hypothalamic worsening, in contrast with children operated by cranial approaches. The surgeon's experience is key in deciding when to stop the dissection. Offering GTR whenever possible aims at avoiding tumor progression and radiotherapy.
Authors: Hermann L Müller; Maithé Tauber; Elizabeth A Lawson; Jale Özyurt; Brigitte Bison; Juan-Pedro Martinez-Barbera; Stephanie Puget; Thomas E Merchant; Hanneke M van Santen Journal: Nat Rev Dis Primers Date: 2022-04-21 Impact factor: 52.329
Authors: Antonio Martínez-Ortega; Álvaro Flores-Martinez; Eva Venegas-Moreno; Elena Dios; Diego Del Can; Eloy Rivas; Ariel Kaen; Eugenio Cárdenas Ruiz-Valdepeñas; Elena Fajardo; Florinda Roldán; Natividad González-Rivera; Rosario Oliva; José Ignacio Fernández-Peña; Alfonso Soto-Moreno; David A Cano Journal: J Clin Med Date: 2022-01-05 Impact factor: 4.241