Surgical Treatment of Craniopharyngiomas in Adults:Comparison between Primary Surgery and Surgery for Recurrence

Objective Few studies have investigated the differences in outcomes between primary and repeat surgery for a craniopharyngioma in adults.As a result,a treatment concept for adult patients with a craniopharyngioma has not yet been established.The present study aimed to retrospectively analyze adult patients with craniopharyngioma to compare surgical outcomes between primary surgery and surgery for recurrence.Methods The demographic and clinical data of 68 adult patients with craniopharyngioma who had primary surgery(n=50)or surgery for recurrence(n=18)were retrospectively analyzed.In addition,the patients were followed up for an average of 38.6 months(range:1–133 months).Results The cohorts of patients undergoing primary surgery or repeat surgery did not differ preoperatively in terms of demographic data,or radiological tumor features.However,patients with recurrent craniopharyngioma had significantly more pituitary hormone deficits and hypothalamo-pituitary disorders before surgery compared with patients with newly diagnosed craniopharyngioma.The success rate of complete resection in primary surgery was 53.2%.Even after repeat surgery,a satisfactory rate of complete resection of 35.7%was achieved.Operative morbidity was increased neither in patients with repeat surgery compared with those with primary surgery(postoperative bleeding P=0.560;meningitis P=1.000;CSF leak P=0.666;visual disturbance P=0.717)nor in patients with complete resection compared with those with partial resection.We found no difference in recurrence-free survival between initial surgery and repeat surgery(P=0.733).The recurrence rate was significantly lower after complete resection(6.9%)than after partial resection(47.8%;P<0.001).Conclusion Attempting complete resection is justified for not only those with newly diagnosed craniopharyngioma but also for those with recurrent craniopharyngioma.However,the surgeon must settle for less than total resection if postoperative morbidity is anticipated.

Microsurgical Treatment of Craniopharyngiomas: A Retrospective Analysis

Objective: This retrospective study aims to survey the clinical outcomes of 341 consecutive patients surgically treated for and diagnosed with craniopharyngioma (CP) treated in a 10-year period in a single institution. Methods: The clinical reports of three hundred forty-one patients CP patients treated surgically between January 2006 and December 2016 were reviewed and analyzed retrospectively. Results: Our cohort consisted of 341 patients (202 male, 139 female) with a mean age of 34.9 years (range 1 - 74 years);Tumor Features: 129 patients (37.8%) had cystic tumors, 88 (23.8%) had solid tumors whereas 126 (36.4%) had heterogeneous lesions with a solid and cystic portion;calcifications were present in 139 (40.8%);Tumor Topography: Suprasellar 198 (58.1%), Intrasellar 40 (11.7%), Intra-third ventricular 103 (30.2%);Surgical approaches used among the patients included: Pterional 262 (76.8%), Transsphenoidal (TS) 42 (12.3%) Transcallosal 20 (5.9%), Transcortical 16 (4.7%) suboccipital 1 and combined approach 1;Gross total removal (GTR) was achieved in 247 patients (72.4%), Subtotal removal (STR) in 94 patients (27.6%). Good postoperative outcome at discharge was achieved in 324 (95%) patients while 17 (5%) patients had poor outcome including 5 (1.5%) perioperative deaths. Mean hospital length of stay was 21.87 (8 - 129). There were 42 (12.9%) recurrences with a mean time to recurrence of 28.36 (3 - 84) months, among which 37 (88.1%) underwent surgery for recurrence treatment. Follow-up time ranged from 3 months to 10 years. There was a statistical significance between open transcranial surgery and suprasellar tumors (p < 0.0001), TS and intrasellar tumors (p < 0.0001);postoperative diabetes inspidus and gross total resection (p < 0.0001);GTR and cystic tumors (p = 0.034) calcification and GTR (p = 0.0008). Conclusion: Good surgical outcome and long-term tumor control can be achieved through individual-based selective resection, whether total or subtotal resection. Whereas surgical prehistory of CP was found to be a significant risk factor to recurrence (p < 0.0001), the clinical risk factors of CP of recurrence are still arguable, including the presence residual tumor due to subtotal resection. More future studies are necessary.

Multi-omics analysis of adamantinomatous craniopharyngiomas reveals distinct molecular subgroups with prognostic and treatment response significance

Background:Adamantinomatous craniopharyngioma(ACP)is the commonest pediatric sellar tumor.No effective drug is available and interpatient heterogeneity is prominent.This study aimed to identify distinct molecular subgroups of ACP based on the multi-omics profiles,imaging findings,and histological features,in order to predict the response to anti-inflammatory treatment and immunotherapies.Methods:Totally 142 Chinese cases diagnosed with craniopharyngiomas were profiled,including 119 ACPs and 23 papillary craniopharyngiomas.Whole-exome sequencing(151 tumors,including recurrent ones),RNA sequencing(84 tumors),and DNA methylome profiling(95 tumors)were performed.Consensus clustering and non-negative matrix factorization were used for subgrouping,and Cox regression were utilized for prognostic evaluation,respectively.Results:Three distinct molecular subgroups were identified:WNT,ImA,and ImB.The WNT subgroup showed higher Wnt/β-catenin pathway activity,with a greater number of epithelial cells and more predominantly solid tumors.The ImA and ImB subgroups had activated inflammatory and interferon response pathways,with enhanced immune cell infiltration and more predominantly cystic tumors.Mitogen-activated protein kinases(MEK/MAPK)signaling was activated only in ImA samples,while IL-6 and epithelial-mesenchymal transition biomarkers were highly expressed in the ImB group,mostly consisting of children.The degree of astrogliosis was significantly elevated in the ImA group,with severe finger-like protrusions at the invasive front of the tumor.The molecular subgrouping was an independent prognostic factor,with the WNT group having longer event-free survival than ImB(Cox,P=0.04).ImA/ImB cases were more likely to respond to immune checkpoint blockade(ICB)therapy than the WNT group(P<0.01).In the preliminary screening of subtyping markers,CD38 was significantly downregulated in WNT compared with ImA and ImB(P=0.01).Conclusions:ACP comprises three molecular subtypes with distinct imaging and histological features.The prognosis of the WNT type is better than that of the ImB group,which is more likely to benefit from the ICB treatment.

Postoperative pituitary hormonal disturbances and hormone replacement therapy time and dosage in children with craniopharyngiomas

Background The proliferative activity and penetration into the hypothalamic structures in children craniopharyngiomas （CP） often make radical resection difficult. Therefore, complete resection of CP often results in permanent multiple pituitary hormone deficiency （MPHD）. This study aimed to elucidate the postoperative pituitary hormonal disturbances, and hormone replacement therapy （HRT） time and dosage in children with CP. Methods Twenty patients with growth retardation and CP after resection, comprising 14 boys and 6 girls, with a mean age of （10.63±3.18） years （Group A） and 10 male patients of group A aged 〉10 years （Group B） were entolled. Thirty age-, sex- and Tanner stage-matched normal children （control Group A）, and 44 male older children 〉10 years （control Group B） served as controls. The serum concentrations of insulin-like growth factor-1 （IGF-1）, growth hormone （GH）, free thyroxine （FT4）, thyroid-stimulating hormone （TSH）, adrenocorticortropic hormone （ACTH）, cortisol （COR）, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin （PRL）, testosterone （T） and estradiol （E2） were measured in the CP patients after resection and in controls. The appropriate time and dosage of HRT were investigated. Linear correlation analysis was made between levothyroxine （L-T4） dosage and primary FT4 in CP patients after resection. Results All cases had MPHD. The serum peak GH, IGF-1, FT4 and COR levels of Group A were significantly lower than that of the control Group A. The serum IGF-1 concentration increased to the normal level after 3 months of rhGH therapy; the serum FSH, LH, and T levels were significantly decreased （P 〈0.001）; however, E2 and PRL were significantly increased （P 〈0.001） in Group B compared with the control Group B; 18 cases were found to have central diabetes insipidus （DI） by water deprivation test and MRI. There was a significant negative linear regression （r=-0.8, P 〈0.001） between L-T4 and primary FT4 in Group A patients with CP after resection, giving a regression equation of L-T4 dosage （μg·kg^-1·d^-1） = 3.5-0.2×FT4 （μg·kg^-1·d^-1）. The time and corresponding dosage of HRT for CP after resection were： rhGH started 1 year after resection and no recurrence of CP on MRI, when IGF-1 reached the normal range, the rhGH dosage was （0.13±0.04） U·kg-1·d-1; hydrocortisone （H-C） was started as soon as possible, and was kept in the lower normal range, at a dosage of （12.6±4.8） mg/m^2; levothyroxine started after H-C or at the same time to maintain FT4 in the higher normal range, at a dosage of （1.65±0.70） μg·kg^-1·d^-1; Minirin （DDAVP） was started as soon as possible, elicited no symptoms, and maintained normal electrolyte levels; the dosage was （0.16±0.04） mg/m^2. Conclusion Patients with CP after resection often displayed MPHD, and needed total HRT at appropriate time and dosage to improve the quality of life and normal growth.

Microsurgical treatment of craniopharyngiomas:report of 284 patients

Background Generally, total surgical removal of craniopharyngioma results in satisfactory outcome with a low recurrence rate, however, the location of the tumor and its adherence to the hypothalamic structures can make the operation difficult. The goal of the present study was to assess the outcome of craniopharyngiomas in 284 patients treated surgically. Methods A total of 284 patients （151 men and 133 women） with craniopharyngioma were treated surgically by our neurosurgeons from January 1996 to March 2006. Among them, 226 （79.6%） patients were adults （15 years of age or older; mean, 35.8 ± 10.6）, 58 （20.4%） were children （14 years of age or younger; mean, 9.1 ± 3.8）. The diameter of the tumors were 2.0-9.0 cm （mean, 36.54± 11.4）. The tumors were classified into the superior （23 patients） and inferior ventricular （261） types according to the location of the tumor relative to the third ventricular floor. For the patients with craniopharyngioma of inferior ventricular type, pterional approach was used in 191 （67.3%） patients, subfrontal approach in 17 （6.0%）, and translamina terminalis through frontobasal interhemispheric approach in 53 08.7%）. For those with the tumors of superior ventricular type, transcallosal approach into the anterior third ventricle was done in 10 （3.5%） patients, and the lamina terminalis approach in 13 （4.6%）. Of the 284 patients, 204 （71.8%） were followed up for 0.5 to 8 years （mean, 2.1 ± 1.8）, including 162 patients received total tumor removal, and 37 underwent subtotal or partial removal. Results Total, subtotal and partial removal of the tumors were achieved in 237 （83.5%）, 34 （12.0%） and 13 （4.5%） patients, respectively. The pituitary stalk was preserved in 176 （62.0%） patients, severed in 52 （18.3%）, and unidentified in 56 （19.7%）. Twelve （4.2%） patients died within one month after the surgery. During the follow-up, 23 （14.1%） patients experienced tumor recurrence 1.0-3.5 years （mean, 1.8± 1.6） after total tumor removal, and 24 （64.9%） had recurrent tumor 0.25- 1.5 years （mean, 0.5 ± 0.4） after subtotal or partial resection. Normal activities of daily living were regained in 63 （80%） patients, independence in 29 （14.2%）, and daily life with assistance in 9 （4.4%）. Four （2.0%） patients died 0.9-3 years （mean, 1.6± 1.4） after discharge from hospital, 3 of them died of hypothalamic deficiency. Conclusions We can protect the hypothalamic structures and its perforating arteries by choosing surgical approaches according to the location of craniopharygioma relative to the third ventricular floor. The mortality, morbidity, and recurrence rate in patients received total resection are lower than those of patients underwent subtotal or partial resections. In addition, preservation of the pituitary stalk is critical when total tumor resection is feasible.

Changes of hypothalamus-pituitary hormones in patients after totalr emoval of craniopharyngiomas

Background This paper aimed to elucidate the changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas. Methods A total of 40 patients with craniopharyngioma s received surgery. The levels of triiodothyronine (T3), thyroxine (T4), thyrotropic hormone (TSH), antidiuretic hormone (ADH), and adrenocorticotropin (ACTH) were measureed in the 40 patients b efore surgery and one week after surgery respectively. Results Twenty-eight patients (70%) had hypothyroidism before surgery, but 38 (95%) had hypothyroidism after surgery (P<0.01). Twenty-three patients (57.5%) had diabetes insipidus (DI) before surgery and 38(95%) had DI after surgery (P<0.001). The pre- and post-operative levels of ADH were (2.49±0.30) pg/ml and (2.80±0.29) pg/ml respectively (P>0.05), whereas tho se of ACTH were (23.97±2.69) pg/ml and (15.60±1.91) pg/ml respectively (P<0.05). Conclusions Hormone deficits after total removal of craniopharyngioma appear to be the common complication of surgery. Hypothyroidism and diabetes insipidus are more frequen t after surgery than before surgery. Thyroxine and glucocorticoids should be administered routinely after total removal of craniopharyngioma.

Multiple inflammatory pseudotumor formation after craniopharyngioma resection via an extended nasal endoscopic approach:A case report

BACKGROUND This report describes a case of intracranial multiple inflammatory pseudotumors(IP)after endoscopic resection of a craniopharyngioma,which is relatively rarely reported in the literature,and neurosurgeons should be aware of its existence.CASE SUMMARY Herein,we report the case of a 56-year-old man who developed decreased visual acuity and blurred vision without obvious cause or inducement on April 27,2020.To seek further treatment,he went to the Department of Neurosurgery,Clinical Medical College,Yangzhou University.After falling ill,there was no nausea,vomiting,limb convulsions,obvious disturbance of consciousness,speech disorders,cough,or persistent fever.The neurological examination findings were normal,and pituitary magnetic resonance imaging(MRI)revealed multiple nodules with abnormal signals in the sellar region.The diagnosis was craniopharyngioma.We performed total resection of the tumor via transnasal endoscopy,and the postoperative pathology suggested that the type of tumor was craniopharyngioma.Six months after the operation,the patient experienced sudden hearing loss in the right ear,tinnitus in both ears,and numbness on the right side of the face and head.Meanwhile,cranial MRI showed multiple IP.After steroid hormone and anti-inflammatory therapy,the above symptoms did not significantly improve.Finally,the patient's symptoms were well improved by surgery,and the postoperative pathological diagnosis was multiple IP.CONCLUSION Intracranial inflammatory pseudotumor is a benign disease with slow progression,but the clinical symptoms and imaging findings are not typical,there are no pathological findings,and the diagnosis is relatively difficult.Most of the cases are treated by surgical resection,and the prognosis is good after surgery.

鼻源性巨大颅咽管瘤1例

1临床资料患者,男,40岁,因左侧鼻塞2个月,加重10天于2015-10-07就诊。患者2个月前无明显诱因出现左侧鼻塞,呈间歇性,并与体位有关,伴有头痛、嗅觉减退,无发热、流涕、鼻出血,曾于当地医院就诊,诊断为慢性鼻炎,给予抗生素类药物治疗,效果欠佳。近10天以来患者鼻塞、头痛加重,自服药物治疗无效,遂来我院就诊。

Endoscopic Assisted Microscopic Surgical Removal of Craniopharyngioma

Background: Craniopharyngioma is a benign tumor which represents 2% - 3% of all intracranial tumors, there are two types: childhood type which affects children between 5 and 10 years and adulthood type which affects patients 50 - 60 years old. The presenting symptoms develop over years and include visual, endocrine, hypothalamic, neurological and neurophysiological manifestations. Surgery is the treatment of choice. Postoperative radiotherapy, gamma-knife and intra tumoral injection of chemotherapeutic drugs have been used as an adjuvant therapy in some cases. Objectives: In this study, we evaluated the role of endoscopy in assisting microscopic surgical removal of craniopharyngioma. Methods: Eleven patients were operated upon in Cairo University Hospitals, Egypt. All operations were done using microscope through the subfrontal approach. At the end of surgery, the endoscope was used to detect any residual tumor in the subchiasmatic and retrochiasmatic areas and to visualize the posterior part of the tumor which couldn’t be seen by the microscope to check if it was adherent to the hypothalamus and to evaluate whether to be removed or not. Results: The study included eleven cases, four of which were childhood type and seven adult type craniopharyngiomas. Total removal was achieved in six cases (five cases of adulthood type). Oumaya reservoir was inserted in five cases;ventriculoperitoneal shunt was needed in five cases. All cases suffered from temporary diabetes insipidus postoperatively, while only two cases developed permanent diabetes insipidus. Three cases presented preoperatively with pituitary hypofunction and two cases developed postoperative pituitary hypofunction, which necessitated hormone replacement therapy. Conclusion: Craniopharyngioma is one of the most difficult and challenging tumors for neurosurgeons due to its relation to optic nerve, hypothalamus and vascular system formed by Willis circle and its perforating branches. Endoscopy has a role in decision making after microscopic removal of craniopharyngioma.

Establishment of primary cultures of craniopharyngioma cells

Craniopharynigoma samples were collected from 36 patients. Out of the 36 samples, 29 achieved successful sub-culturing, with a success rate of 80.6%. Immunohistochemistry staining showed that cytokeratin-7 was positively expressed in the cytomembrane and cytoplasm of craniopharyngioma cells at 6-8 passages, confirming that all cultured cells were squamous epithelial cells. The doubling time of craniopharyngioma cells was 3 days, as confirmed by the 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide assay. In this study, craniopharyngioma cells cultured in vitro were established; however, establishment of immortalized craniopharyngioma cell lines requires further research.

Growth hormone ameliorates hepatopulmonary syndrome and nonalcoholic steatohepatitis secondary to hypopituitarism in a child:A case report

BACKGROUND Craniopharyngioma is a benign tumor that usually develops in children;however,it is located in the center and close to sensitive structures,such as the pituitary gland and hypothalamus.As the hypothalamus plays a crucial role in the homeostasis of anterior pituitary hormone synthesis,damage to the hypothalamus leads to multiple pituitary hormone deficiencies and non-alcoholic fatty liver disease,including hepatopulmonary syndrome(HPS).HPS has limited treatment and poor prognosis.CASE SUMMARY A girl aged 13 years and 6 mo underwent surgery for craniopharyngioma 6 years prior.Right craniotomy was performed with total resection via the corpus callosum approach,and the tumor at the base was approximately 3.5 cm×3.5 cm×4.0 cm.At 1 year postoperatively,she exhibited abdominal distension and weakness,and the laboratory tests revealed fatty liver disease.Thereafter,she had not visited the outpatient clinic for 2 years.Two years ago,she developed decreased activity endurance,severe cyanosis,chest tightness,wheezing,and intermittent and recurrent low fever after mild physical labor.Hepatobiliary ultrasonography,liver biopsy,and contrast echocardiography of the right heart showed cirrhosis and multiple pituitary hormone deficiencies,indicating HPS.After 1 year of treatment with recombinant human growth hormone,the liver function and oxygenation improved;she did not undergo liver transplantation.CONCLUSION Craniopharyngioma surgery can easily cause hypopituitarism,which can lead to nonalcoholic steatohepatitis and HPS in children.Early growth hormone therapy is important to improve the prognosis of these diseases.

Cerebral venous sinus thrombosis following transsphenoidal surgery for craniopharyngioma:A case report

BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery.After admission,head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus,edema at the bilateral parietal lobe,and hemorrhage at the left parietal lobe and right occipital lobe;the venous phase of cerebral angiography revealed CVST.The patient was treated immediately by intravenous thrombolysis,endovascular thrombolysis,and mechanical thrombectomy after the definite diagnosis.However,the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.CONCLUSION For craniopharyngioma undergoing transsphenoidal surgery,it is vital to take an effective strategy to manage the postoperative complications,such as diabetes insipidus,severe electrolyte imbalance,and cerebrospinal fluid leakage.Additionally,the early differential diagnosis of CVST is essential when it develops clinical symptoms,especially in patients following transsphenoidal surgery with a high risk of CVST.Subsequently,the timely and effective treatment of the CVST is critical for preventing neurological deterioration.

Clinical, Pathological and Surgical Risk Factors Associated with Craniopharyngioma Recurrence: A Literature Review

Objective: This review article attempts to examine and provide an overview of the risk factors associated with craniopharyngioma recurrence. Methods: A literature review of articles relating to the recurrences of craniopharyngioma and the clinical, molecular prognostic indicators of recurrence and treatment outcomes was performed retrospectively. Results: A total of 107 studies which described specific risk factors related to craniopharyngioma recurrence were identified which included but not limited to 54 retrospective case series, 7 systematic reviews, 21 laboratory reports, 13 case reports and 12 literature reviews. Conclusion: Based on the evidence identified in this review, the risk factors for recurrence in craniopharyngioma management are interrelated in a complex way, and surgery with or without adjuvant radiotherapy is reported to be of long-term benefit, but a disparity in findings suggests no definitive consensus on the risk factors of craniopharyngioma recurrence. More high-quality research is needed.

Endoscopic Skull Base Surgery in Assiut University, Single Center Early Experience

Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department, Assiut University Hospital, Assiut University, Assiut, Egypt in a period of 3 years (2015, 2016, 2017) and operated by endoscopic transnasal approach. All patients signed an informed consent. Results: With the highest percentage was pituitary adenoma 56%, pituitary apoplexy 12%, craniopharyngioma 12%, CSF rhinorrhea 12%, Planum sphenoidal meningioma 4% and suprasellar granuloma 4%. 88% of patients were operated without complications, 8% mortality rate postoperative, 12% complication rate and 76% complete improvement postoperative. Conclusion: Endoscopic skull base surgery is a safe approach to the skull base that needs a good experience, practice and good anatomical knowledge. Teamwork between a Neurosurgeon and ENT surgeon is a must for patient safety.

Ectopic recurrence craniopharyngioma:series report and literature review

Background Craniopharyngioma is a common intracranial tumor located in the sellar-suprasellar region.Due to the involvement of adjacent structures,it can lead to increased intracranial pressure,visual impairment,and endocrine deficiencies.Surgical resection is the primary treatment,but it is a tough challenge to achieve total resection,which will led to the frequency of recurrences and progressions.Among them,distant spread is extremely rare,but important complication,identifying and providing proper therapy,is crucial.Methods We report two cases of ectopic recurrence craniopharyngioma and make a literature review for the published similar case reports.Results Our literature review revealed 63 cases(including our patient).The onset age in children group and adult group ranges from 2-14 years old(6.70±3.33)to 17-73 years old(40.63±15.58),while the interval year between tumor initiation and ectopic recurrence ranges from 0.17-20(7.28±6.76)years to 0.3-34(6.85±7.29).Achieving gross total resection seems not to prevent the ectopic recurrence.The major pathology of ectopic recurrence craniopharyngioma is adamantinomatous type.The most common site of ectopic recurrence is frontal lobe.According to the pathogenesis,35 cases were seeding along the surgical approach,and 28 cases were seeding via the CSF pathway.Conclusion Ectopic recurrence craniopharyngioma is rare,but it can lead to serious symptoms.Delicate surgical procedure can help to reduce the risk of ectopic recurrence,and standardized follow-up can provide valuable information for treatment.

Malignant transformation of craniopharyngioma in an infradiaphragmatic case

Till now, 13 cases of malignant craniopharyngioma （CP） have been reported around the world, including 11 cases of transformation from benign tumors and 2 cases of congenital ones. Irradiation seemed to contribute a lot to the cellular transformation. The controversies about the radical surgery or irradiation have not ceased for many decades. In this article, we report a case of infradiaphragmatic CP （Id-CP） in a child who experienced almost all current treatments. However, after multiple tumor recurrences, finally the malignant transformation occurred. The analysis of the tumor regrowth pattem and clinical characteristics provided some clues to standardize and individualize the treatment of Id-CP.

Frontolateral Approach Applied to Sellar Region Lesions： A Retrospective Study in 79 Patients

Background： Various surgical approaches for the removal of sellar region lesions have previously been described. This study aimed to evaluate the reliability and safety of the frontolateral approach （FLA） to remove sellar region lesions. Methods： We presented a retrospective study of 79 patients with sellar region lesions who were admitted and operated by the FLA approach from August 2011 to August 2015 in Department of Neurosurgery of Beijing Tian Tan Hospital. We classified FLA into three types, compared the FLA types to the areas of lesion invasion, and analyzed operation bleeding volume, gross total resection （GTR） rate, visual outcome, and mortality. Results： Seventy-nine patients were followed up from 2.9 to 50.3 months with a mean follow-up of 20.5 months. There were 42 cases of meningiomas, 25 cases of craniopharyngiomas, and 12 cases of pituitary adenomas. The mean follow-up Karnofsky Performance Scale was 90.4. GTR was achieved in 75 patients （94.9%）. Two patients （2.5%） had tumor recurrence. No patients died perioperatively or during short-term follow-up. Three patients （3.8%） with craniopharyngioma died 10, 12, and 23 months, respectively, after surgery. The operative bleeding volume of this study was no more than that of the other approaches in the sellar region （P = 0.783）. In this study, 35 patients （44.3%） had visual improvement after surgery, 38 patients （48.1%） remained unchanged, and three patients＇ visual outcome （3.8%） worsened. Conclusions： FLA was an effective approach in the treatment of sellar region lesions with good preservation of visual function. FLA classification enabled tailored craniotomies for each patient according to the anatomic site of tumor invasion. This study found that FLA had similar outcomes to other surgical approaches of sellar region lesions.

Microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach

Background Craniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.Methods Fifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen,the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed. Results Of the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).Conclusions Microsurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.

Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

Background: The extrapontine myelinolysis (EPM) of osmotic demyelination syndrome (ODS) is a rare and dangerous disorder of the central nervous system. The mechanism is not fully understood and the treatment is controversial. There are few reports of EPM occurred after endonasal endoscopic resection of pediatric craniopharyngioma. Case presentation: We report two unusual cases of such a rare condition. Both are procedured uneventful endonasal endoscopical craniopharyngioma resection, after operation, the patients suffered serious diabetic insipidus with remarkable fluctuation of serum sodium though we applied pitutrin continual management to maintain everyday normal urine and correct serum sodium disorder. MR images occured caudal and lentiform nuclei myelinolysis following these serious conditions. Conclusions: In this study relevant literatures are reviewed in order to further understand this complication and contribute to the prevention and treatment of EPM caused by inappropriate correction of serum sodium disorder.

Comparative analysis on microsurgical removal of craniopharyngioma via lateral supraorbital approach and standard pterional approach

Background: Craniopharyngioma is a kind of intracranial benign tumor that is primarily treated with surgery. At present, a variety of surgical approaches are used for tumor resection. We have conducted a comparative analysis of the two approaches most used in our department. Methods: The study retrospectively analyzed the clinical data from 65 patients with craniopharyngioma surgically treated by the two approaches mentioned above. Among these patients, 24 were treated by lateral supraorbital (LSO) approach and 41 by standard pterional approach. Indicators including, but not limited to, length of incision, operation time, postoperative pituitary function, urine volume, visual function improvement, and hospitalization were used to compare these two groups of patients. Results: The data shows that there was no significant difference in total tumor resection rate (P=0.54), postoperative visual field improvement (P=0.68) and postoperative function of endocrine. However, the LSO approach significantly reduced the operative incision (P=0.001), shortened the operation time (P=0.001) and operative complexity, while reducing the incidence of postoperative complications (P=0.04). Conclusions: In surgical treatment of craniopharyngioma, LSO approach has similar surgical effect with standard pterional approach, but it can significantly shorten the operation time, reduce surgical trauma and the incidence of complications. Therefore, LSO provides another alternative to surgical approach for microsurgical removal of craniopharyngioma.