Radiosurgery of Craniopharyngeomas in Combination with Stereotactic Methods


Authors: T. Chytka 1;  R. Liščák 1;  V. Vladyka 1;  V. Dbalý 2;  P. Štursa 3;  M. Syrůček 4
Authors‘ workplace: Nemocnice Na Homolce, Praha ;  Oddělení stereotaktické a radiační neurochirurgie 1;  Neurochirurgické oddělení 2;  Radiodiagnostické oddělení 3;  Oddělení patologické anatomie 4
Published in: Cesk Slov Neurol N 2008; 71/104(5): 565-575
Category: Short Communication

Overview

During 2/96–8/01 18 patients with craniopharyngioma were treated by stereotactic minimally invasive methods in our department at the Na Homolce Hospital and subsequently monitored for at least 5 years. The solid part of the craniopharyngioma was treated using gamma knife radiosurgery, the cystic parts of the tumor were treated with stereotactic aspiration or intracavitary brachytherapy. In a group of 18 patients (5 women, 13 men) treated with radiosurgery, the age varied from 7 to 73 (median 24) years. Fourteen patients underwent open partial resection before stereotactic radiosurgery (three patients were re‑operated), one patient underwent endoscopic partial operation, two patients had a shunt operation for their hydrocephalus, one patient underwent stereotactic biopsy, and one patient underwent external fractionated radiotherapy. The minimum marginal dose was in the range 12 to 35 (median 16) Greys, the median tumor volume was 3650 mm3. The follow up evaluation was 1–104 (median 61) months. Fifteen patients showed clinical improvement, three worsened clinically and died as a result of their tumour. Post‑radiation follow‑up imaging showed a reduction in tumour size in eleven patients (61 %) and no further tumour growth in 5 patients (27 %). One patient was found to have a larger tumour (6 %) 2 years after gamma knife treatment and this patient underwent repeated opened resection but died due to post‑operative complications. One patient had no follow up imaging, because he did not come for check–up, and died 7 months after gamma knife treatment. It is often necessary to apply a multidisciplinary approach in treating craniopharyngioma. If craniopharyngioma cannot be completely removed by means of surgery there are other treatment modalities, including stereotactic radiosurgery, that should be taken into consideration. Our results in a group of 18 patients proved the value of stereotactic radiosurgery as an adjuvant radiation treatment (15 patients), as an alternative to open surgery (3 patients) and the value of intracavitary irradiation radiosurgery (8 patients); in the case of one patient we show that it is possible to verify pathological diagnosis by stereotactic biopsy.

Key words:
craniopharyngioma – stereotactic surgery – intracavitary irradiation radiosurgery – stereotactic biopsy


Sources

1. Náhlovský J. Neurochirurgie. Praha: Galén 2006: 167–168.

2. Osborn AG. Diagnostic neuroradiology. St Louis: Mosby 1994: 654–657.

3. Kleihues P, Burger PC, Scheithauer W et al (eds). Histological typing of tumours of the central nervous system. Berlin: Springer-Verlag 1971: 49–50.

4. Adamson TE, Wiestler OD, Kleihues P, Yaşargil MG. Correlation of clinical and pathological features in surgically treated craniopharyngiomas. J Neurosurg 1990, 73(1): 12–17.

5. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM. The descriptive epidemiology of craniopharyngioma. J Neurosurg 1998; 89(4): 547–551.

6. Kozler P et al. Intrakraniální nádory. Praha: Galén 2007: 183–185.

7. Thapar K, Kovacz K. Neoplasms of the sellar region. In Bigner DD, McLendon RE, Bruner JM (eds). Russel & Rubistein‘s pathology of tumours of the Nervous system. 6th ed. London: Arnold 1998: 561–567.

8. Harwood-Nash DC. Neuroimaging of childhood craniopharyngioma. Pediatr Neurosurg 1994: 21 (Suppl 1): 2–10.

9. Vladyka V, Šubrt O, Liščák R. Radiochirurgie s užitím gama nože. Rozhl Chir 1994; 73: 348–355.

10. Liščák R, Vladyka V, Šubrt O. Leksellův Gama nůž: radiochirurgický nástroj. Čas Lék čes 1998; 137: 154–157.

11. Liščák R, Vladyka V, Šubrt O, Novotný J, Masopust J, Šup I. Stereotaktická brachyterapie cystického kraniofaryngeomu pomocí izotopu Yttria90. Cesk Slov Neurol N 1997; 60/93(4): 196–202.

12. Lunsford LD. Stereotactic treatment of craniofaryngioma. Intracavitary irradiation and radiosurgery. Cont Neurosurg 1989; 11(2): 1–6.

13. Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H et al. Craniopharyngioma – a long‑term results following limited surgery and radiotherapy. Radiother Oncol 1993; 26: 1–10.

14. Crotty TB, Scheithauer BW, Young WF jr, Davis DH, Schaw EG, Miller GM et al. Papillary craniopharyngioma: a clinicopathological study of 48 cases. J Neurosurg 1995; 83(2): 206–214.

15. Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas. Approaches and long‑term results in 144 patients. J Neurosurg 1990; 73(1): 3–11.

16. Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D et al. Craniopharyngiomas: a clinocopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 1994; 35(6): 1001–1010.

17. Baskin DS, Wilson CB. Surgical management of craniopharyngioma. A review of 74 cases. J Neurosurg 1986; 65(1): 227–237.

18. Hoffman HJ, De Silva M, Humphreys RP, Drake JM, Smith ML, Blazer S. Aggresive surgical management of craniopharyngiomas in children. J Neurosurg 1992; 76(1): 47–52.

19. Laws ER jr. Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 1980; 52(5): 661–666.

20. Regine WF, Kramer S. Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys 1992; 24(4): 611–617.

21. Symon L, Sprich W. Radical excision of craniopharyngioma. Results in 20 patients. J Neurosurg 1985; 62(2): 174–181.

22. Trippi AQC, Garner JT, Kassabian JT, Hunter Shelden C. A new approach to in­operable craniopharyngioma. Am J Surg 1969; 118(2): 307–310.

23. Steno J, Malacek M, Bizik I. Tumor-third ventricular relationship in supradiaphragmatic Craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 2004; 54(5): 1051–1060.

24. Lunsford LD, Pollock BE, Kondziolka DS, Levine G, Flickinger JC. Stereotactic options in the management of craniopharyngioma. Pediatr Neurosurg 1994; 21 (Suppl 1): 90–97.

25. Harris JR, Levene MB. Visual complications following iradiation for pituitary adenomas and craniopharyngiomas. Radiology 1976; 120(1): 167–171.

26. Tsang RW, Laperriere NJ, Simpson WJ, Brierly J, Panzarella T, Smyth HS. Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk. Cancer 1993; 72(7): 2227–2233.

27. Kristopaitis T, Thomas C, Petruzzelli GJ, Lee JM. Malignant craniopharyngioma. Arch Pathol Lab Med 2000; 124(9): 1356–1360.

28. Flickinger JC, Lunsford LD, Singer J, Cano E, Deutsch M. Megavoltage external beam irradiation of craniopharyngiomas: analysis of tumor control and morbidity. Int J Radiat Oncol Biol Phys 1990; 19(1): 117–122.

29. Varlotto JM, Flickinger JC, Kondziolka D, Lunford LD, Deutsch M. External beam irradiation of craniofaryngiomas: long‑term analysis of tumor control and morbidity. Int J Radiat Oncol Biol Phys 2002; 54(2): 492–499.

30. Leksell L, Backlund EO, Johansson L. Treatment of craniopharyngioma. Acta Chir Scand 1967; 133(5): 345–350.

31. Wycis HT, Robbins R, Spiegel-Adolf M, Meszaros J, Spiegel EA. Studies in stereoencephalotomy. III; treatment of cystic craniopharyngioma by injection of radioactive P 32. Confin Neurol 1954; 14(4): 193–202.

32. Backlund EO. Colloidal radioisotopes as part of multi‑modality treatment of craniopharyngiomas. J Neurosurg Sci 1989; 33(1): 95–97.

33. Pollack IF, Lunsford LD, Slamovits TL, Gumerman LW, Levine G, Robonson AG. Stereotaxic intracavitary irradiation for cystic craniopharyngiomas. J Neurosurg 1988; 68(2) 227–233.

34. Voges J, Sturm V, Lehrke R, TreuerH, Gauss C, Berthold F. Cystic cra­nio­pha­­-­­­ryngioma: long‑term results after intra­­­cavitarry irradiation with steretac­tically app­lied collodial beta‑emitting radiactive sources. Neurosurgery 1997; 40(2): 263–268.

35. Prasad D, Steiner M. Gamma knife surgery for craniopharyngioma. Acta Neurochir (Wien) 1995; 134(3–4): 167–176.

36. Cavalheiro S, Sparapani FV, Franco JO, da Silva MC, Braga FM. Use of bleomycin in intratumoral chemotherapy for cystic craniopharyngioma. J Neurosurg 1996; 84(1): 124–126.

37. Broggi G, Giorgi C, Franzini A, Servello D, Solero CL. Preliminary results of intracavitary treatment of craniopharyngioma with bleomycin. J Neurosurg Sci 1989; 33(1): 145–148.

38. Gutin PH, Klemme WM, Lagger RL, MacKay AR, Pitts LH, Hojobuchi Y. Managenet of unresectable cystic craniopharyngioma by aspiration through an Ommaya reservoar drainage system. J Neurosurg 1980; 52(1): 36–40.

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

Labels
Paediatric neurology Neurosurgery Neurology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account