Abstract
Background
The surgical management of craniopharyngiomas has been among the most challenging neurosurgical procedures because of their complex topographical relationship with surrounding structures and high recurrence rate after subtotal resection. Craniopharyngiomas have been classified only by their location to determine an appropriate surgical approach without due regard to other factors that could affect the surgical results, such as the extent of adhesion to surrounding structures or the nature of the tumor.
Methods
We describe the role of the diaphragm sellae on the growth patterns of craniopharyngiomas from surgical experiences and pathological evidences, suggesting the classification of craniopharyngiomas into three categories by the level of origin and the competence of the diaphragm sellae: a tumor of subdiaphragmatic origin with competent diaphragm sellae, subdiaphragmatic with incompetent diaphragm sellae, and supradiaphragmatic.
Discussion
Tumors in each category have shown peculiar topographical relationship with the optic chiasm, third ventricle, and also adhesion extents. The nature of the tumor itself, e.g., the composition of cystic and solid parts, may bring additional minor variations to the topographical features of a craniopharyngioma, but will maintain the major characteristics determined by its level of origin and competence of the diaphragm sellae.
Conclusion
This classification scheme, which considers the origin level, is clinically relevant and useful because optimal surgical approaches could be designed by considering multiple factors affecting surgical procedure and outcome, including the expected extent of adhesion and preferred sites of recurrence, as well as the topographical location of the tumor. In subdiaphragmatic tumors, which correspond to intrasellar and prechiasmatic tumors, a transsphenoidal approach could be reasonably attempted even with considerable suprasellar extensions because they tend to adhere to the intrasellar structures, and the superior surface of the tumor may be easily separated from the brain structures by pulling. Supradiaphragmatic tumors, however, may need a wider surgical approach that can provide direct vision of the tumor because of possible extensive adhesion.
Similar content being viewed by others
References
Eldevik OP, Blaivas M, Gabrielsen TO, Hald JK, Chandler WF (1996) Craniopharyngioma: radiologic and histologic findings and recurrence. Am J Neuroradiol 17:1427–1439
Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250
Hoffman HJ (1994) Surgical management of craniopharyngioma. Pediatr Neurosurg 21(Suppl 1):44–49
Im SH, Wang KC, Kim SK, Chung YN, Kim HS, Lee CH, Cho BK (2003) Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method. Pediatr Neurosurg 39:97–103
Kim SK, Wang KC, Shin SH, Choe G, Chi JG, Cho BK (2001) Radical excision of pediatric craniopharyngioma: recurrence pattern and prognostic factors. Childs Nerv Syst 17:531–536
Konig A, Ludecke DK, Herrmann HD (1986) Transnasal surgery in the treatment of craniopharyngiomas. Acta Neurochir (Wien) 83:1–7
Maira G, Anile C, Colosimo C, Cabezas D (2000) Craniopharyngiomas of the third ventricle: trans-lamina terminalis approach. Neurosurgery 47:857–863
Sorva R, Jaaskinen J, Heiskanen O, Perheentupa J (1988) Postoperative computed tomographic control of 38 patients with craniopharyngioma. Surg Neurol 29:115–119
Stahnke N, Grubel G, Lagenstein I, Willig RP (1984) Long-term follow-up of children with craniopharyngioma. Eur J Pediatr 142:179–185
Steno J, Malacek M, Bizik I (2004) Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 54:1051–1058
Symon L (1983) Microsurgery of the hypothalamus with special reference to craniopharyngioma. Neurosurg Rev 6:43–49
Tomita T, McLone DG (1993) Radical resections of childhood craniopharyngiomas. Pediatr Neurosurg 19:6–14
Villani RM, Tomei G, Bello L, Sganzerla E, Ambrosi B, Re T, Giovanelli Barilari M (1997) Long-term results of treatment for craniopharyngioma in children. Childs Nerv Syst 13:397–405
Wang KC, Kim SK, Choe G, Chi JG, Cho BK (2002) Growth patterns of craniopharyngioma in children: role of the diaphragm sellae and its surgical implication. Surg Neurol 57:25–33
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, KC., Hong, S.H., Kim, SK. et al. Origin of craniopharyngiomas: implication on the growth pattern. Childs Nerv Syst 21, 628–634 (2005). https://doi.org/10.1007/s00381-005-1203-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-005-1203-8