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Craniopharyngiomas: The correlation between histological features and long-term prognosis
5240
Tumours of the CNS - Craniopharyngiomas and Pituitary Tumours
Results : There was a striking heterogeneity of the microvascu lature within meningioma. No significant corre lation between micro vascu lar proliferation and recurrency was found . Discussion and Conclusions: The results of this study suggest no correlation between ang iogenesis and recurrence. Hence , in mening iomas extens ive neovascularization does not arise as an expression of biological aggressiveness.
Thursday, 10 July 1997
parti ally improv ed. Radiation was applied in 24 patients. 6 patie nts (8%) died in the period of study. Th e results we re bette r in total resection than in partial resection and this was also reported by other authors . The age groups . symptoms and neurologic exam ination findings in our series are generally in agreement with the literature.
IP-5-610 I craniopharyngioma Tran~sphenoidal microsurgery for Chen Mingzhe n, Wan Haijun . Department of Neurosurgery, First Affiliated
Hospital. Sun Yat Sen University of MedicalSciences. Guangzhou, PR China
Thursday, 10 July 1997
14:00-16:15
P-5 Tumours of the eNS Craniopharyngiomas and Pituitary Tumours
Ip-5-60a] histological Craniopharyngiomas: The correlation between features and long-term prognosis Lj. Dordic , M. Jan ieijevie . V. Antuno vtc, M. Rakie. M. Oklobdz ija, M. Gajie.
M. .Jokovlc. Institute for Neurosurgery Clinical Centerof Serbia. Belgrade. Yugoslavia Introduction: Craniopharyngiomas. those controvers ial tumors occurring in children and in adults are believed to be of disembrional origin. Almost half of cases are see n in adults. but relative frequency (of all intracranial tumors ) is 6-7 times higher in children . The reason for this is in fact that other intracranial tumors are much more frequent in adults. The prognosis is very different for children and adults . Purpose: We tried to find out if there were some specific histological features predicting bette r prognosis. Material: We have analyzed all patients with craniopharyngiomas operated on in 25 years period at Institute of neurosurgery. Belgrade (1967-1992). The mean follow-up period was approximately 10 years (114 months) . Results: In children we found 7%. and in adults 1% of all intracranial tumo rs 10 be craniopharyngiomas. The mean age was 22.4 years (1--B3). children (less than 18 years ) 58% (73 patients ) and adults 42% (53). There was male predominance in children (56%). and in adults the sex dist ribution was 50:50. The most frequent approaches were pterional 54%. and subfrontal unilateral 27% . Complete (25%) and subtotal removal (52%) were achieved in major ity of cases n %. Dividing all tumors in two groups on the basis of Giangaspero criteria (1984 ) we found all tumors in children to be of adamantinous subtyp e. In adults approx imately 1/3 patients have papillous type . In long term follow-up period, we found the tumors of papillous type to have much better proqnosis (expected survival 15 years and more is 38% for adamantinous and 69% for papillous tumors ). Cons idering that in children we had only adamantinous type of craniopharyngioma we analyzed expected surviva l for child ren and adults and found 28% and 65% survival rate for 15 years respect ively. No diffe rences were found in radicality and postoperat ive radiation therap y accord ing to histology, that could influence the survival. Conclusion: Adamantinous subtype predict s worse long term prognos is in craniopharyngiomas. All children and adolescents were found to have tumors of adamantonous type , and that is probably the reason for worse prognos is in them .
I P-5-6091 Craniopharyngiomas: Analysis of 68 surgical cases N. Oral, A. Yurt, M. Arda, T. D6nmez, Z. Sekerci, Social SecurityHospital.
Department of Neurosurgery, Ankara. Turkey Between 1983-1996. 68 patients with craniopharyng iomas were operated. (39 males , 29 females). The youngest patient was 4 ye ars old . the oldes t 62. (Average 22.7); 35 pat ients were unde r 16 years old . The most common sympto m was headac he (65.7%) and nausea (57%) in childre n and vision defect (75%) in adults . Neurologic investigation revealed visual field defects in 36 (52%). papiledema in 22 (32%) , and opti c atrophy in 23 (33%) cases ; 55 cases (80%) showed endocrine disorders; 22 (32% ) pat ients were hypothyroid; 17 (25%) were hypoadrenal and clinical diabetes incipidus was apparent in 16 (23%). 32 (47%) were localized retroch iasmatic. 19 (27%) were infra- and suprasellar, 10 (14%) were prechiasmatic , 5 (7%) were intraven tricular and 2 (3%) were intrasellar. All patients had CT; 26 pat ients had MRI. 26 patients (39%) had total remo val of the tumour , 42 patients (61%) had subtota l removal. In 11 patie nts (30% ), vision improved , 14 patients (36%)
We report on our series of 15 craniopharyngioma cases operated on by the tran soral or transnasal transsphenoidal approach since 1991. Of the 15 patients . 8 were males and 7 were femal es. with a mean age of 37 years (range 6-60 years). CT was performed preoperatively, tumor was stere o-local ized by contrast enhanced CT with axial planes and coronal-sagittal reconstruction. Total removal of the tumor was achieved in 7 pat ients (46%) and subtotal excision in 6 patients (40%). In two cases (14%) the tumor was partially removed. All patients had improved after surgery. There was no operative death or major complications. Radiological evidence of tumor disappearance was seen in 9 cases after a mean 3.5 years period of follow up . Recurrence was seen in 2 cases. We believe that the transsphenoidal approach is an effective method for treating intrasellar and suprasellar cran iopharyngioma with enlarg ement of the sella.
IP-5-611 I A study of malignant craniopharyngioma Hirotsugu Samejima, Kou Oka , Hitoshi Kimura, Keiitirou Kasai, Yukio Ushikubo , Morikazu Ueda , Kei Takahash i, Masamiti Hara 1 . Ohashi
Hospital. Iono University, Tokyo, Japan, I Urafune Hospital. Yokohama City University. Yokohama. Japan Introduction: Craniopharyngiomas are congen ital and usually benign . Husell , Rubinste in and ZUlch have reported that there was no literature concerning a truly malignant craniopharyngioma. In this paper, we would like to present the case of an adult patient with malignant craniopharyngioma. Case : A 45 year old male initially complained of a right visual disturba nce in 1986 and a homogeneously enhanc ing mass lesion was found by CT and MRI in supra sella r region . The tumor was remo ved and diagnosed as a typical adamant inomatous type of craniophary ngioma. Postoperative radiotherapy was done by using Co, 60 Gy. After that he returned to normal life. CT and MRI were examined twice yearly and showed no evidence of tumor activity. Eight years thereafter. patient's psycholog ical condition had dete riorated. In the following year he was blind in the right eye. Regro wth of the tumor was found by CT and MRI and was cente red in the suprasellar cistern. The tumor had also invaded the third ventricle and hypoth alamus . A second operation was perf ormed by th e interhem ispheric trans- lamina terminalis approach . Pathological results showed poorly differentiated squamous cell carcinoma. It had developed cont iguously from the craniopharyngioma, wh ich was the original component of the tumor. The stratified large atyp ical cells invaded the sur rounding tissues. Two months afte r the operation. a small tumor appeared in the subcutaneous region of his forehead and MRI showed meningeal seedings with lumps in the frontal base. After his death . the autopsy revealed that the same mal ignan t cell s had infiltrated the third ventricle, interhemispheric fissure and frontal base . The re was no evidence of malignancy in other organs . Discussion: There have been only two cases among the reports found in Japan , which ment ion the mal ignant transformation of craniopharyngioma. With regard to effects from radiotherapy. our case does not correspond with Caha n's category of radiation-induced tumo rs becaus e of the primary cells found in the second tumor. The fact that maligna nt tumors develop from craniopharyngioma should be carefully considered and exp lored in the future treatmen t of this tumor.
IP-5-612I
Surgical experience in pituitary adenomas
A. Ramada n. Y. AI-Awadi. Department of Neurosurgery, Ibn Sina Hospital.
Satat, Kuwait Different modalities have been recommended for treatment of pituitary ade nomas includ ing surgical and non-surgical methods. Between 1988-1995,219 patients were investigate d and ope rated upon in Ibn Sina Hospital ; 173 patient s (79% were operated by the trans-sphenoidal approach, and in only 3 patients (1.5%) combined approaches were used. Bas ed on clinical, and endoc rinological manifes tation . pituitary adenomas were divided into: Non-Secreting Adenomas. and Secret ing Adenomas. The later was divided in several SUb-groups. According to this classification . the 219 patients are distributed as follows: 87 patients with non-secreting (39.8%); 66 patients with proclactinomas (30.0%) ; 46 patients with acrome galy (21.0%); 20 patients with Cushing dise ase (9.2%).
Tumours of the CNS - Craniopharyngiomas and Pituitary Tumours
Results : There was a striking heterogeneity of the microvascu lature within meningioma. No significant corre lation between micro vascu lar proliferation and recurrency was found . Discussion and Conclusions: The results of this study suggest no correlation between ang iogenesis and recurrence. Hence , in mening iomas extens ive neovascularization does not arise as an expression of biological aggressiveness.
Thursday, 10 July 1997
parti ally improv ed. Radiation was applied in 24 patients. 6 patie nts (8%) died in the period of study. Th e results we re bette r in total resection than in partial resection and this was also reported by other authors . The age groups . symptoms and neurologic exam ination findings in our series are generally in agreement with the literature.
IP-5-610 I craniopharyngioma Tran~sphenoidal microsurgery for Chen Mingzhe n, Wan Haijun . Department of Neurosurgery, First Affiliated
Hospital. Sun Yat Sen University of MedicalSciences. Guangzhou, PR China
Thursday, 10 July 1997
14:00-16:15
P-5 Tumours of the eNS Craniopharyngiomas and Pituitary Tumours
Ip-5-60a] histological Craniopharyngiomas: The correlation between features and long-term prognosis Lj. Dordic , M. Jan ieijevie . V. Antuno vtc, M. Rakie. M. Oklobdz ija, M. Gajie.
M. .Jokovlc. Institute for Neurosurgery Clinical Centerof Serbia. Belgrade. Yugoslavia Introduction: Craniopharyngiomas. those controvers ial tumors occurring in children and in adults are believed to be of disembrional origin. Almost half of cases are see n in adults. but relative frequency (of all intracranial tumors ) is 6-7 times higher in children . The reason for this is in fact that other intracranial tumors are much more frequent in adults. The prognosis is very different for children and adults . Purpose: We tried to find out if there were some specific histological features predicting bette r prognosis. Material: We have analyzed all patients with craniopharyngiomas operated on in 25 years period at Institute of neurosurgery. Belgrade (1967-1992). The mean follow-up period was approximately 10 years (114 months) . Results: In children we found 7%. and in adults 1% of all intracranial tumo rs 10 be craniopharyngiomas. The mean age was 22.4 years (1--B3). children (less than 18 years ) 58% (73 patients ) and adults 42% (53). There was male predominance in children (56%). and in adults the sex dist ribution was 50:50. The most frequent approaches were pterional 54%. and subfrontal unilateral 27% . Complete (25%) and subtotal removal (52%) were achieved in major ity of cases n %. Dividing all tumors in two groups on the basis of Giangaspero criteria (1984 ) we found all tumors in children to be of adamantinous subtyp e. In adults approx imately 1/3 patients have papillous type . In long term follow-up period, we found the tumors of papillous type to have much better proqnosis (expected survival 15 years and more is 38% for adamantinous and 69% for papillous tumors ). Cons idering that in children we had only adamantinous type of craniopharyngioma we analyzed expected surviva l for child ren and adults and found 28% and 65% survival rate for 15 years respect ively. No diffe rences were found in radicality and postoperat ive radiation therap y accord ing to histology, that could influence the survival. Conclusion: Adamantinous subtype predict s worse long term prognos is in craniopharyngiomas. All children and adolescents were found to have tumors of adamantonous type , and that is probably the reason for worse prognos is in them .
I P-5-6091 Craniopharyngiomas: Analysis of 68 surgical cases N. Oral, A. Yurt, M. Arda, T. D6nmez, Z. Sekerci, Social SecurityHospital.
Department of Neurosurgery, Ankara. Turkey Between 1983-1996. 68 patients with craniopharyng iomas were operated. (39 males , 29 females). The youngest patient was 4 ye ars old . the oldes t 62. (Average 22.7); 35 pat ients were unde r 16 years old . The most common sympto m was headac he (65.7%) and nausea (57%) in childre n and vision defect (75%) in adults . Neurologic investigation revealed visual field defects in 36 (52%). papiledema in 22 (32%) , and opti c atrophy in 23 (33%) cases ; 55 cases (80%) showed endocrine disorders; 22 (32% ) pat ients were hypothyroid; 17 (25%) were hypoadrenal and clinical diabetes incipidus was apparent in 16 (23%). 32 (47%) were localized retroch iasmatic. 19 (27%) were infra- and suprasellar, 10 (14%) were prechiasmatic , 5 (7%) were intraven tricular and 2 (3%) were intrasellar. All patients had CT; 26 pat ients had MRI. 26 patients (39%) had total remo val of the tumour , 42 patients (61%) had subtota l removal. In 11 patie nts (30% ), vision improved , 14 patients (36%)
We report on our series of 15 craniopharyngioma cases operated on by the tran soral or transnasal transsphenoidal approach since 1991. Of the 15 patients . 8 were males and 7 were femal es. with a mean age of 37 years (range 6-60 years). CT was performed preoperatively, tumor was stere o-local ized by contrast enhanced CT with axial planes and coronal-sagittal reconstruction. Total removal of the tumor was achieved in 7 pat ients (46%) and subtotal excision in 6 patients (40%). In two cases (14%) the tumor was partially removed. All patients had improved after surgery. There was no operative death or major complications. Radiological evidence of tumor disappearance was seen in 9 cases after a mean 3.5 years period of follow up . Recurrence was seen in 2 cases. We believe that the transsphenoidal approach is an effective method for treating intrasellar and suprasellar cran iopharyngioma with enlarg ement of the sella.
IP-5-611 I A study of malignant craniopharyngioma Hirotsugu Samejima, Kou Oka , Hitoshi Kimura, Keiitirou Kasai, Yukio Ushikubo , Morikazu Ueda , Kei Takahash i, Masamiti Hara 1 . Ohashi
Hospital. Iono University, Tokyo, Japan, I Urafune Hospital. Yokohama City University. Yokohama. Japan Introduction: Craniopharyngiomas are congen ital and usually benign . Husell , Rubinste in and ZUlch have reported that there was no literature concerning a truly malignant craniopharyngioma. In this paper, we would like to present the case of an adult patient with malignant craniopharyngioma. Case : A 45 year old male initially complained of a right visual disturba nce in 1986 and a homogeneously enhanc ing mass lesion was found by CT and MRI in supra sella r region . The tumor was remo ved and diagnosed as a typical adamant inomatous type of craniophary ngioma. Postoperative radiotherapy was done by using Co, 60 Gy. After that he returned to normal life. CT and MRI were examined twice yearly and showed no evidence of tumor activity. Eight years thereafter. patient's psycholog ical condition had dete riorated. In the following year he was blind in the right eye. Regro wth of the tumor was found by CT and MRI and was cente red in the suprasellar cistern. The tumor had also invaded the third ventricle and hypoth alamus . A second operation was perf ormed by th e interhem ispheric trans- lamina terminalis approach . Pathological results showed poorly differentiated squamous cell carcinoma. It had developed cont iguously from the craniopharyngioma, wh ich was the original component of the tumor. The stratified large atyp ical cells invaded the sur rounding tissues. Two months afte r the operation. a small tumor appeared in the subcutaneous region of his forehead and MRI showed meningeal seedings with lumps in the frontal base. After his death . the autopsy revealed that the same mal ignan t cell s had infiltrated the third ventricle, interhemispheric fissure and frontal base . The re was no evidence of malignancy in other organs . Discussion: There have been only two cases among the reports found in Japan , which ment ion the mal ignant transformation of craniopharyngioma. With regard to effects from radiotherapy. our case does not correspond with Caha n's category of radiation-induced tumo rs becaus e of the primary cells found in the second tumor. The fact that maligna nt tumors develop from craniopharyngioma should be carefully considered and exp lored in the future treatmen t of this tumor.
IP-5-612I
Surgical experience in pituitary adenomas
A. Ramada n. Y. AI-Awadi. Department of Neurosurgery, Ibn Sina Hospital.
Satat, Kuwait Different modalities have been recommended for treatment of pituitary ade nomas includ ing surgical and non-surgical methods. Between 1988-1995,219 patients were investigate d and ope rated upon in Ibn Sina Hospital ; 173 patient s (79% were operated by the trans-sphenoidal approach, and in only 3 patients (1.5%) combined approaches were used. Bas ed on clinical, and endoc rinological manifes tation . pituitary adenomas were divided into: Non-Secreting Adenomas. and Secret ing Adenomas. The later was divided in several SUb-groups. According to this classification . the 219 patients are distributed as follows: 87 patients with non-secreting (39.8%); 66 patients with proclactinomas (30.0%) ; 46 patients with acrome galy (21.0%); 20 patients with Cushing dise ase (9.2%).