Craniopharyngioma and Rathke’s cleft cysts

Both craniopharyngiomas and Rathke’s cysts are rare pituitary lesions of dysembryogenic origin. Their radiological differentiation may be sometimes difficult due to their occasionally similar imaging characteristics. The surgical management of these lesions, especially of craniopharyngiomas, may be very challenging. Gross total removal of a craniopharyngioma is associated with longer recurrence-free survival but could be associated with higher rate of surgery-related morbidities and pituitary insufficiency. Craniopharyngiomas are considered in the majority of cases to be a ‘chronic disease’. A principle difference in the operative management of these two lesions is that in craniopharyngiomas, resection of their thicker capsule is mandatory in order to achieve complete removal, whereas it is nearly impossible and not recommended to attempt such cyst wall removal in Rathke’s cysts. Emptying of the cyst content is usually sufficient to provide cure in the majority of these patients. Recurrences in Rathke’s cyst are only rarely observed in contrast to craniopharyngiomas.

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Comprehensive Analysis of Imaging Features, Immunohistochemistry and Prognosis of Hepatocellular Carcinoma Patients with Human Immunodeficiency Virus

10.21203/rs.2.21987/v1 ◽

2020 ◽

Author(s):

Xi Xu ◽

Qingxin Gan ◽

Lieguang Zhang ◽

Deyang Huang ◽

Chengcheng Yu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Human Immunodeficiency Virus ◽

Tumour Size ◽

Postoperative Recurrence ◽

Recurrence Free Survival ◽

Ki 67 ◽

Free Survival ◽

Imaging Characteristics ◽

Immunodeficiency Virus ◽

Age Range

Abstract Background: This study aims to provide clues for the preoperative and prognostic assessment of hepatocellular carcinoma (HCC) patients with human immunodeficiency virus (HIV) by comparing the imaging characteristics, immunohistochemistry and prognosis of HCC patients with and without HIV infection.Methods: The study reviewed two databases, one for HIV-HCC patients and the other for HCC patients who were not infected with HIV. The inclusion criteria were surgically resected and pathologically diagnosed hepatocellular carcinoma patients from October 2013 to August 2016. This study collected 11 HIV-HCC patients (11 men; median age 45 years old, age range 33~71 years) and 11 HCC patients without HIV infection (11 men; median age 50 years old, age range 42~61 years). The image characteristics of HCC were analysed by computed tomography (CT) imaging. In addition, samples were obtained from resected specimens for immunohistochemical analysis, and the expression of glypican-3 (GPC-3), CD34 and Ki-67 were measured. The independent-samples t test, Fisher exact test and Wilcoxon test were used for comparisons. Kaplan-Meier plots were used for postoperative recurrence-free survival analysis.Results: The median diameter of the largest nodule was significantly larger in the HIV-HCC patients than in the HCC group (P=0.027). In addition, the HIV-HCC patients presented significantly higher CD34 and GPC-3 expression than the HCC patients (P=0.031, 0.007, respectively). Moreover, the postoperative recurrence-free survival time was significantly shorter in the HIV-HCC patients than in the HCC patients (Log-Rank test, c2=6.076, P=0.014), with respective median durations of 4 months and 28 months, respectively. Multivariate Cox model analysis revealed that GPC-3 expression and tumour size were independent prognosis factors in the HCC patients (HR = 4.506, 95% CI :1.247-16.278, P= 0.022; HR = 1.479, 95% CI :1.137-1.923, P = 0.022, respectively).Conclusion: Compared to HCC patients with non-HIV infection, HIV-HCC patients frequently present a larger tumour size and high expression of CD34 and GPC-3, which result in shorter postoperative recurrence-free survival. Observing the tumour expression of CD34, GPC-3, and Ki-67 and imaging characteristics could be helpful in providing a basis for the choice of treatment strategies and the prognosis evaluation of patients.

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Endoscopic Endonasal Approach for a Suprasellar Craniopharyngioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1623522 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S241-S242

Author(s):

Georgios Zenonos ◽

Carl Snyderman ◽

Paul Gardner

Keyword(s):

Clinical Outcome ◽

Outcome Measures ◽

Vision Loss ◽

Recurrence Free Survival ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Free Survival ◽

Imaging Characteristics

Objectives The current video presents the nuances of an endoscopic endonasal approach to a suprasellar craniopharyngioma. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon, at a teaching academic institution. Participants The case refers to a 67-year-old man who presented with vision loss and headaches, and was found to have a suprasellar mass, with imaging characteristics consistent with a craniopharyngioma. Main Outcome Measures The main outcome measures consistent of the reversal of the patient symptoms (vision loss and headaches), the recurrence-free survival based on imaging, as well as the absence of any complications. Results The patient's vision improved after the surgery; at his last follow-up there was no evidence of recurrence on imaging. Conclusions The endoscopic endonasal approach is safe and effective in treating suprasellar craniopharyngiomas.The link to the video can be found at: https://youtu.be/p1VXbwnAWCo.

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Interhemispheric, Translamina Terminalis Approach for the Resection of Suprasellar Cavernous Malformation

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1624588 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S278-S278

Author(s):

Georgios Zenonos ◽

Paul Gardner

Keyword(s):

Outcome Measures ◽

Vision Loss ◽

Cavernous Malformation ◽

Third Ventricle ◽

Recurrence Free Survival ◽

Cavernous Malformations ◽

Free Survival ◽

The Third ◽

Imaging Characteristics

Objectives The current video presents the nuances of an interhemispheric, translamina terminalis approach for the resection of suprasellar cavernous malformation. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team at a teaching academic institution. Participants The case refers to a 64-year-old female who presented with vision loss and confusion, and was found to have a suprasellar mass, with imaging characteristics consistent with a cavernous malformation of the third ventricle. Main Outcome Measures The main outcome measures consist of the reversal of the patient symptoms (vision loss and confusion), the recurrence-free survival based on imaging, as well as the absence of any complications. Results The patient's mental status improved slightly after surgery. There was no evidence of recurrence. Conclusions The interhemispheric, translamina terminalis approach is safe and effective for the resection of suprasellar cavernous malformations.The link to the video can be found at: https://youtu.be/z6RSAM_GnBA.

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Risk Factors of Pituitary Insufficiency in Children and Adolescents with Rathke's Cleft Cysts.

10.1210/endo-meetings.2010.part3.p14.p3-692 ◽

2010 ◽

pp. P3-692-P3-692

Author(s):

HH Lim ◽

MJ Kang ◽

IS Yun ◽

JH Kim ◽

SH Lee ◽

...

Keyword(s):

Risk Factors ◽

Children And Adolescents ◽

Pituitary Insufficiency ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

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EXTENDED ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL APPROACH FOR THE REMOVAL OF SUPRASELLAR TUMORS

Neurosurgery ◽

10.1227/01.neu.0000249211.89096.25 ◽

2007 ◽

Vol 60 (1) ◽

pp. 46-59 ◽

Cited By ~ 210

Author(s):

Enrico de Divitiis ◽

Luigi Maria Cavallo ◽

Paolo Cappabianca ◽

Felice Esposito

Keyword(s):

Cerebrospinal Fluid ◽

Pituitary Adenomas ◽

Cerebrospinal Fluid Leak ◽

Complete Removal ◽

Transsphenoidal Approach ◽

Endoscopic Endonasal ◽

Rathke's Cleft Cysts ◽

Tuberculum Sellae ◽

Rathke's Cleft ◽

Fluid Leak

Abstract OBJECTIVE The widespread use of the endoscope in transsphenoidal pituitary surgery has recently contributed to the extension of the approach beyond the tuberculum sellae and planum sphenoidale for the management of lesions located in the suprasellar area, either with an endoscope-assisted or purely endoscopic technique. Based on our previous experience with more than 450 standard endoscopic transsphenoidal operations, we have retrospectively evaluated the effectiveness of the extended endoscopic endonasal transsphenoidal approach in the management of lesions mainly located in the suprasellar area. METHODS Between January 2004 and December 2005, 20 consecutive patients underwent extended endoscopic endonasal transsphenoidal surgery for a total of 21 procedures. The series consisted of seven pituitary adenomas, seven craniopharyngiomas, three suprasellar Rathke's cleft cysts, two tuberculum sellae meningiomas, and one pilocytic astrocytoma of the chiasm. RESULTS Tumor removal, as assessed by postoperative magnetic resonance imaging, revealed complete removal of the lesion in four out of seven pituitary adenomas, five out of seven craniopharyngiomas, three out of three Rathke's cleft cysts, and two out of two tuberculum sellae meningiomas. One patient (5%) with craniopharyngioma had a postoperative cerebrospinal fluid leak that required reoperation. The same patient experienced a sphenoid mycosis, which was treated with medical therapy. Some specific conditions associated with the anatomy of the surgical route, as well as to the morphology of the lesion, have resulted to condition the feasibility of the approach. CONCLUSION Small and medium sized suprasellar lesions located in the midline, with or without a limited parasellar extension and without involvement of vascular structures, seem amenable to be resected through such extended endoscopic transsphenoidal approach. Improvements in closure techniques and the use of new materials and surgical glues seem to significantly reduce the postoperative cerebrospinal fluid leak rate and meningitis.

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