Current Management of Craniopharyngiomas
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Pediatric Dermatology and Allergy (J Lee, Section Editor)
Current Management of Craniopharyngiomas Maeher Grewal, BS1 Daniel B. Spielman, MD1 Jonathan B. Overdevest, MD, PhD1 Marc Otten, MD2 Jeffrey Bruce, MD2 David A. Gudis, MD1,* Address *,1 Department of Otolaryngology – Head and Neck Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue Suite 850, New York, NY, 10032, USA Email: [email protected] 2 Department of Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
* Springer Nature Switzerland AG 2020
Topical Collection on Pediatric Dermatology and Allergy Keywords Craniopharyngioma I Skull base tumor I Endoscopic skull base surgery
Abstract Purpose of review This paper reviews the current management of craniopharyngioma tumors with a focus on surgical treatment options. Recent findings Advances in transnasal endoscopic skull base surgery and proton therapy have altered the management options available for this challenging condition. Summary Craniopharyngiomas are benign suprasellar tumors that originate from Rathke’s pouch. These complex lesions may cause major neurologic, endocrine, and visual deficits. Treatment modalities include endoscopic transnasal versus open transcranial surgery to achieve gross total or subtotal resection. Various forms of radiation therapy are often integral to comprehensive management of craniopharyngiomas. This article reviews current treatment modalities and surgical risks, highlighting differences between endoscopic versus transcranial surgical approaches.
Introduction Craniopharyngiomas (CPs) are benign squamous cell epithelial tumors that arise from Rathke’s pouch and grow into the suprasellar region. They make up 2–4% of all
intracranial tumors and account for up to 10% of pediatric brain tumors. While there is no gender or race predilection, there is a bimodal age presentation with a pediatric peak
Pediatric Dermatology and Allergy (J Lee, Section Editor) between 5 and 15 years and an adult peak between 50 and 70 years [1]. These different peaks also mark a difference in histopathology: the adamantinomatous type can be seen in both age groups but is more common in pediatric patients, while the papillary type is rarely seen in children and is predominantly seen in the adult patient population [2, 3]. Although CPs themselves are classified as WHO Grade I tumors, their suprasellar location and thus their ability to grow into and impinge on important nearby structures like the optic chiasm, hypothalamus, pituitary stalk, and Circle of Willis can cause complex deficits that require intervention [4]. These include but are not limited to vision loss, severe headaches, failure to thrive, weight gain, loss of energy and libido, and other hypothalamicpituitary axis neuroendocrinopathies; these are also commonly the presenting symptoms of CPs [1, 5]. Unfortunately, the proximity of CPs to the aforementioned vital structures is also one of t
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