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Outcome After Resection of Craniopharyngiomas and the Important Role of Stereotactic Radiosurgery in Their Management

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Gamma Knife Neurosurgery in the Management of Intracranial Disorders II

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 128))

Abstract

Objective: Experience with management of craniopharyngiomas (CPH) was evaluated retrospectively.

Methods: Between 1981 and 2012, 100 patients underwent removal of a CPH (the main surgical group), and an original tumor grading system was applied to these cases. The mean length of follow-up was 121 months. Additionally, 17 patients underwent removal of a CPH between 2012 and 2017 (the supplementary surgical group), and in 6 of them, CyberKnife radiosurgery was performed on a residual tumor (in 5 cases) or at the time of recurrence (in 1 case).

Results: In the main surgical group, the gross total resection (GTR) rate was 81%. The early and late disease-specific postoperative mortality rates were 0% and 2%, respectively. Tumor recurrence was never noted after GTR. There was a statistically significant increase in the Karnofsky Performance Scale (KPS) score after surgery. The tumor surgical grade was inversely associated with both the pre- and postoperative KPS scores, and was lower in cases operated on via the transnasal transsphenoidal approach, but was unrelated to the GTR rate. In the supplementary surgical group, the GTR rate was 65%. CyberKnife radiosurgery consistently resulted in tumor shrinkage.

Conclusion: GTR is the preferred management option for CPH. The original surgical grading system developed at Tokyo Women’s Medical University may be helpful for clinical decision-making. CyberKnife radiosurgery for residual and recurrent CPH is associated with high tumor response rates.

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References

  1. El Khamlichi A, Melhaoui A, Arkha Y, Jiddane M, El Gueddari BK. Role of Gamma Knife radiosurgery in the management of pituitary adenomas and craniopharyngiomas. Acta Neurochir Suppl. 2013;116:49–54.

    PubMed  Google Scholar 

  2. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg. 1999;90:237–50.

    Article  CAS  PubMed  Google Scholar 

  3. Hetelekidis S, Barnes PD, Tao ML, Fischer EG, Schneider L, Scott RM, Tarbell NJ. 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys. 1993;27:189–95.

    Article  CAS  PubMed  Google Scholar 

  4. Hoffman HJ, De Silva M, Humphreys RP, Drake JM, Smith ML, Blaser SI. Aggressive surgical management of craniopharyngiomas in children. J Neurosurg. 1992;76:47–52.

    Article  CAS  PubMed  Google Scholar 

  5. Hori T, Kawamata T, Amano K, Aihara Y, Ono M, Miki N. Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle. Neurosurgery. 2010;66(3 Suppl Operative):65–74.

    PubMed  Google Scholar 

  6. Hori T, Kawamata T, Amano K, Aihara Y, Okada Y, Ono M, Miki N. Proposal of a new grading system based on surgical results of 100 craniopharyngiomas. J Neurol Neurophysiol. 2014;5(1):187.

    Google Scholar 

  7. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg. 2008;108:715–28.

    Article  PubMed  Google Scholar 

  8. Morisako H, Goto T, Goto H, Bohoun CA, Tamrakar S, Ohata K. Aggressive surgery based on an anatomical subclassification of craniopharyngiomas. Neurosurg Focus. 2016;41(6):E10.

    Article  PubMed  Google Scholar 

  9. Veeravagu A, Lee M, Jiang B, Chang SD. The role of radiosurgery in the treatment of craniopharyngiomas. Neurosurg Focus. 2010;28(4):E11.

    Article  PubMed  Google Scholar 

  10. Yamada S, Fukuhara N, Oyama K, Takeshita A, Takeuchi Y, Ito J, Inoshita N. Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery. World Neurosurg. 2010;74:320–30.

    Article  PubMed  Google Scholar 

  11. 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;73:3–11.

    Article  PubMed  Google Scholar 

  12. Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD. Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Neurosurgery. 2006;59:244–54.

    Article  PubMed  Google Scholar 

  13. Kobayashi T, Kida Y, Mori Y, Hasegawa T. Long-term results of Gamma Knife surgery for the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg. 2005;103(6 Suppl):482–8.

    PubMed  Google Scholar 

  14. Kobayashi T. Long-term results of Gamma Knife radiosurgery for 100 consecutive cases of craniopharyngioma and a treatment strategy. Prog Neurol Surg. 2009;22:63–76.

    Article  PubMed  Google Scholar 

  15. Hori T. What is the role of radiosurgery in the management of sellar tumors? Acta Neurochir Suppl. 2013;116:45–8.

    PubMed  Google Scholar 

  16. Yomo S, Hayashi M, Chernov M, Tamura N, Izawa M, Okada Y, Hori T, Iseki H. Stereotactic radiosurgery of residual or recurrent craniopharyngioma: new treatment concept using Leksell Gamma Knife model C with automatic positioning system. Stereotact Funct Neurosurg. 2009;87:360–7.

    Google Scholar 

  17. Yomo S, Konishi Y, Hayashi M. Long-term treatment results of Gamma Knife stereotactic radiosurgery for craniopharyngioma. Jpn J Neurosurg (Tokyo). 2015;24:535–43. (in Japanese)

    Article  Google Scholar 

  18. Albright AL, Hadjipanayis CG, Lunsford LD, Kondziolka D, Pollack IF, Adelson PD. Individualized treatment of pediatric craniopharyngiomas. Childs Nerv Syst. 2005;21:649–54.

    Article  PubMed  Google Scholar 

  19. Elliott RE, Jane JA Jr, Wisoff JH. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery. 2011;69:630–43.

    Article  PubMed  Google Scholar 

  20. Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery. 2012;70:110–24.

    Article  PubMed  Google Scholar 

  21. Mortini P, Losa M, Pozzobon G, Barzaghi R, Riva M, Acerno S, Angius D, Weber G, Chiumello G, Giovanelli M. Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. J Neurosurg. 2011;114:1350–9.

    Article  PubMed  Google Scholar 

  22. Shi XE, Wu B, Zhou ZQ, Fan T, Zhang YL. Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin Med J. 2006;119(19):1653–63.

    Article  PubMed  Google Scholar 

  23. Van Effenterre R, Boch AL. Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg. 2002;97:3–11.

    Article  PubMed  Google Scholar 

  24. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33:610–8.

    CAS  PubMed  Google Scholar 

  25. Murphy ES, Chao ST, Angelov L, Vogelbaum MA, Barnett G, Jung E, Recinos VR, Mohammadi A, Suh JH. Radiosurgery for pediatric brain tumors. Pediatr Blood Cancer. 2016;63:398–405.

    Article  PubMed  Google Scholar 

  26. Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M. Craniopharyngioma—long-term results following limited surgery and radiotherapy. Radiother Oncol. 1993;26:1–10.

    Article  CAS  PubMed  Google Scholar 

  27. Prasad D, Steiner M, Steiner L. Gamma Knife surgery for craniopharyngioma. Acta Neurochir (Wien). 1995;134:167–76.

    Google Scholar 

  28. Mokry M. Craniopharyngiomas: a six year experience with Gamma Knife radiosurgery. Stereotact Funct Neurosurg. 1999;72(Suppl 1):140–9.

    Article  PubMed  Google Scholar 

  29. Chung WY, Pan DH, Shiau CY, Guo WY, Wang LW. Gamma Knife radiosurgery for craniopharyngiomas. J Neurosurg. 2000;93(Suppl 3):47–56.

    Article  PubMed  Google Scholar 

  30. Yu X, Liu Z, Li S. Combined treatment with stereotactic intracavitary irradiation and Gamma Knife surgery for craniopharyngiomas. Stereotact Funct Neurosurg. 2000;75:117–22.

    Article  CAS  PubMed  Google Scholar 

  31. 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;3:159–66.

    Google Scholar 

  32. Barajas MA, Ramírez-Guzmán G, Rodríguez-Vázquez C, Toledo-Buenrostro V, Velásquez-Santana H, del Robles RV, Cuevas-Solórzano A, Rodríguez-Hernández G. Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery. J Neurosurg. 2002;97(5 Suppl):607–9.

    Article  PubMed  Google Scholar 

  33. Ulfarsson E, Lindquist C, Roberts M, Rähn T, Lindquist M, Thorén M, Lippitz B. Gamma Knife radiosurgery for craniopharyngiomas: long-term results in the first Swedish patients. J Neurosurg. 2002;97(5 Suppl):613–22.

    Google Scholar 

  34. Amendola BE, Wolf A, Coy SR, Amendola MA. Role of radiosurgery in craniopharyngiomas: a preliminary report. Med Pediatr Oncol. 2003;41:123–7.

    Article  PubMed  Google Scholar 

  35. Hasegawa T, Kobayashi T, Kida Y. Tolerance of the optic apparatus in single-fraction irradiation using stereotactic radiosurgery: evaluation in 100 patients with craniopharyngioma. Neurosurgery. 2010;66:688–95.

    Article  PubMed  Google Scholar 

  36. Niranjan A, Kano H, Mathieu D, Kondziolka D, Flickinger JC, Lunsford LD. Radiosurgery for craniopharyngioma. Int J Radiat Oncol Biol Phys. 2010;78:64–71.

    Article  PubMed  Google Scholar 

  37. Xu Z, Yen CP, Schlesinger D, Sheehan J. Outcomes of Gamma Knife surgery for craniopharyngiomas. J Neurooncol. 2011;104:305–13.

    Google Scholar 

  38. Saleem MA, Hashim AS, Rashid A, Ali M. Role of Gamma Knife radiosurgery in multimodality management of craniopharyngioma. Acta Neurochir Suppl. 2013;116:55–60.

    Article  PubMed  Google Scholar 

  39. Lee CC, Yang HC, Chen CJ, Hung YC, Wu HM, Shiau CY, Guo WY, Pan DH, Chung WY, Liu KD. Gamma Knife surgery for craniopharyngioma: report on a 20-year experience. J Neurosurg. 2014;121(Suppl):179–87.

    Google Scholar 

  40. Kobayashi T, Tsugawa T, Hatano M, Hashizume C, Mori Y, Shibamoto Y. Gamma Knife radiosurgery of craniopharyngioma: results of 30 cases treated at Nagoya Radiosurgery Center. Nagoya J Med Sci. 2015;77:447–54.

    PubMed  PubMed Central  Google Scholar 

  41. Dho YS, Kim YH, Kim JW, Park CK, Chung HT, Kim SK, Paek SH, Wang KC, Kim DG. Optimal strategy of Gamma Knife radiosurgery for craniopharyngioma. J Neurooncol. 2018;140:135–43.

    Google Scholar 

  42. Losa M, Pieri V, Bailo M, Gagliardi F, Barzaghi LR, Gioia L, Del Vecchio A, Bolognesi A, Mortini P. Single fraction and multisession Gamma Knife radiosurgery for craniopharyngioma. Pituitary. 2018;21:499–506.

    Article  PubMed  Google Scholar 

  43. Minniti G, Esposito V, Amichetti M, Maurizi Enrici R. The role of fractionated radiotherapy and radiosurgery in the management of patients with craniopharyngioma. Neurosurg Rev. 2009;32:125–32.

    Article  CAS  PubMed  Google Scholar 

  44. Gopalan R, Dassoulas K, Rainey J, Sherman JH, Sheehan JP. Evaluation of the role of Gamma Knife surgery in the treatment of craniopharyngiomas. Neurosurg Focus. 2008;24(5):E5.

    Article  PubMed  Google Scholar 

  45. Lee M, Kalani MY, Cheshier S, Gibbs IC, Adler JR, Chang SD. Radiation therapy and CyberKnife radiosurgery in the management of craniopharyngiomas. Neurosurg Focus. 2008;24(5):E4.

    Article  PubMed  Google Scholar 

  46. Varlotto J, DiMaio C, Grassberger C, Tangel M, Mackley H, Pavelic M, Specht C, Sogge S, Nguyen D, Glantz M, Saw C, Upadhyay U, Moser R, Yunus S, Rava P, Fitzgerald T, Glanzman J, Sheehan J. Multi-modality management of craniopharyngioma: a review of various treatments and their outcomes. Neurooncol Pract. 2016;3:173–87.

    PubMed  Google Scholar 

  47. Iwata H, Tatewaki K, Inoue M, Yokota N, Baba Y, Nomura R, Shibamoto Y, Sato K. Single and hypofractionated stereotactic radiotherapy with CyberKnife for craniopharyngioma. J Neurooncol. 2012;106:571–7.

    Google Scholar 

  48. Murphy MJ, Chang SD, Gibbs IC, Le QT, Hai J, Kim D, Martin DP, Adler JR Jr. Patterns of patient movement during frameless image-guided radiosurgery. Int J Radiat Oncol Biol Phys. 2003;55:1400–8.

    Article  PubMed  Google Scholar 

  49. Conti A, Pontoriero A, Ghetti I, Senger C, Vajkoczy P, Pergolizzi S, Germanò A. Benefits of image-guided stereotactic hypofractionated radiation therapy as adjuvant treatment of craniopharyngiomas: a review. Childs Nerv Syst. 2019;35:53–61.

    Article  PubMed  Google Scholar 

  50. Giller CA, Berger BD, Pistenmaa DA, Sklar F, Weprin B, Shapiro K, Winick N, Mulne AF, Delp JL, Gilio JP, Gall KP, Dicke KA, Swift D, Sacco D, Harris-Henderson K, Bowers D. Robotically guided radiosurgery for children. Pediatr Blood Cancer. 2005;45:304–10.

    Article  PubMed  Google Scholar 

  51. Ohhashi G, Miyazaki S, Ikeda H, Hori T. Postoperative long-term outcomes of patient with craniopharyngioma based on CyberKnife treatment. Cureus. 2020;12(3):e7207.

    Google Scholar 

  52. Timmerman R, Papiez L, Suntharalingam M. Extracranial stereotactic radiation delivery: expansion of technology beyond the brain. Technol Cancer Res Treat. 2003;2:153–60.

    Article  PubMed  Google Scholar 

  53. Pham CJ, Chang SD, Gibbs IC, Jones P, Heilbrun MP, Adler JR Jr. Preliminary visual field preservation after staged CyberKnife radiosurgery for perioptic lesions. Neurosurgery. 2004;54:799–812.

    Article  PubMed  Google Scholar 

  54. Constine LS, Randall SH, Rubin P, McDonald J. Craniopharyngiomas: fluctuation in cyst size following surgery and radiation therapy. Neurosurgery. 1989;24:53–9.

    Article  CAS  PubMed  Google Scholar 

  55. Mazerkina NA, Savateev AN, Gorelyshev SK, Konovalov AN, Trunin YY, Golanov AV, Medvedeva OA, Kalinin PL, Kutin MA, Astafieva LI, Krasnova TS, Ozerova VI, Serova NK, Butenko EI, Strunina YV. Transient enlargement of craniopharyngioma cysts after stereotactic radiotherapy and radiosurgery. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(6):40–7. (in Russian)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Moriyama Neurological Center Hospital, Tokyo, Japan

    Tomokatsu Hori

  2. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Tomokatsu Hori, Kosaku Amano & Takakazu Kawamata

  3. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Motohiro Hayashi

  4. Saitama Gamma Knife Center, Sanai Hospital, Saitama, Japan

    Motohiro Hayashi

  5. Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan

    Genichiro Ohhashi & Shinichiro Miyazaki

  6. Department of Endocrinology, Tokyo Neurological Center Hospital, Tokyo, Japan

    Masami Ono & Nobuhiro Miki

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  1. Tomokatsu Hori
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  2. Kosaku Amano
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  3. Takakazu Kawamata
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  4. Motohiro Hayashi
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  5. Genichiro Ohhashi
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  6. Shinichiro Miyazaki
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  7. Masami Ono
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  8. Nobuhiro Miki
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Correspondence to Tomokatsu Hori .

Editor information

Editors and Affiliations

  1. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov

  2. Gamma Knife Unit, Department of Neurosurgery, and Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Tokyo, Japan

    Motohiro Hayashi

  3. Department of Neurosurgery, University of Minnesota Medical School, Minnesota, MN, USA

    Clark C. Chen

  4. Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ian E. McCutcheon

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Hori, T. et al. (2021). Outcome After Resection of Craniopharyngiomas and the Important Role of Stereotactic Radiosurgery in Their Management. In: Chernov, M.F., Hayashi, M., Chen, C.C., McCutcheon, I.E. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders II. Acta Neurochirurgica Supplement, vol 128. Springer, Cham. https://doi.org/10.1007/978-3-030-69217-9_3

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  • DOI: https://doi.org/10.1007/978-3-030-69217-9_3

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