Multimodality Treatment of Craniopharyngioma: Aspiration of Cystic Contents and Placement of Ommaya Reservoir Stereotactically Followed by Gamma Knife Radiosurgery – Single Center Study of 81 Cases
Objective: The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi.
Material and Methods: After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided.
Result: The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case, and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient.
Conclusion: Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods
2. Chu C, Su Y, Lieu A, Lin C, Kwan A. Comparison Study of Clinical Presentation and Surgical Outcome between Children and Adults with Craniopharyngioma: A 22-Year Single-Center Experience in Southern Taiwan. J Neurol Disord. 2017; 5 (350): 2.
3. Attuati L, Picozzi P. Radiotherapy and Radiosurgery for Craniopharyngiomas. In Diagnosis and Management of Craniopharyngiomas, 2016: (pp. 101-112). Springer, Cham.
4. 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 Journal of Medical Science, 2015; 77 (3): 447.
5. Müller HL. Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity. Current Opinion in Endocrinology, Diabetes, and Obesity, 2016; 23 (1): 81.
6. Lania A, Spada A, Lasio G. Diagnosis and management of craniopharyngiomas. Springer International Publishing, 2016.
7. Lubuulwa J, Miao Z, Liu S, Chen J, Wang S, Jiang W, Shu K, Lei T. Clinical, Pathological and Surgical Risk Factors Associated with Craniopharyngioma Recurrence: A Literature Review. Neurosurgery, 2019; 9: 61-77.
8. Muskens IS, Najafabadi AH, Briceno V, Lamba N, Senders JT, van Furth WR, Verstegen MJ, Smith TR, Mekary RA, Eenhorst CA, Broekman ML. Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis. Pituitary, 2017; 20 (5): 539-52.
9. 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 craniopharyngiomas. Journal of Neuro-Oncology, 2018; 140 (1): 135-43.
10. 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 (5): 499-506.
11. Bishop AJ, Grosshans DR. Craniopharyngioma. InRadiation Oncology for Pediatric CNS Tumors, 2018: pp. 295-309. Springer, Cham.
12. Kobayashi T, Kida Y, Mori Y, Hasegawa T. Long-term results of gamma knife surgery in the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg. 2005; 103 (6 Suppl): 482-8.
13. Gopalan R, Dassoulas K, Rainey J, Sherman JH, Sheehan JP. Evaluation of the role of Gamma Knife surgery in the treatment of craniopharyngiomas. Neurosurgical Focus, 2008; 24 (5): E5.
14. Xu Z, Yen CP, Schlesinger D, Sheehan J: Outcomes of Gamma Knife surgery for craniopharyngiomas. J Neurooncol. 2011; 104: 305–313.
15. 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: 688–695.
16. 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.
17. Ulfarsson E, Lindquist E, Roberts M, Rähn T, Lindquist M, Thorén M, et al. Gamma Knife radiosurgery for craniopharyngiomas: Long-term results in the first Swedish patients. J Neurosurg. 2002; 97 (5 Suppl): 613-22.
18. Chung WY, Pan DH, Shiau CY, Guo WY, Wang LW. Gamma knife radiosurgery for craniopharyngiomas. J Neurosurg. 2000; 93 (3 Suppl): 47-56.
19. Juloori A, Murphy ES. Pediatric Radiosurgery. In Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy, 2019: 331-343. Springer, Cham.
20. Saleem MA, Hashim AS, Rashid A, Ali M. Role of gamma knife radiosurgery in multimodality management of craniopharyngioma. InGamma Knife Neurosurgery in the Management of Intracranial Disorders, 2013: 55-60. Springer, Vienna.
21. Mortini P, Gagliardi F, Bailo M, Losa M. Surgical Approach to Craniopharyngiomas: Transcranial Routes. In Diagnosis and Management of Craniopharyngiomas, 2016: 85-99. Springer, Cham.
Copyright (c) 2020 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.