الفهرس 
Embryology and Anatomy Development of the pituitary gland and sellaOnly 14 pages are availabe for public view
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Abstract
Craniopharyngioma is a slowly growing intracranial tumor, relatively
common in childhood. Craniopharyngioma represents between 2 and 5% of
primary central nervous system (CNS) tumors (Bunin et al., 1998). Though
histologically benign, their clinical behavior shows semimalignant features
because of their tendency to recur, their location is closely related with
critical structures such as the optic chiasm and tract, hypothalamus, third
ventricle, pituitary gland, or carotid artery and because they grow into
neighboring tissues with finger-like projections which make the feasibility of
radical resection difficult even in the microneurosurgery era. Presentation and
side effects of treatment include visual disturbances, pituitary insufficiency,
hypothalamic dysfunction, behavioral disturbances, and memory deficits.
Regardless of the therapeutic modality chosen, tumor recurrence is common
(Elliott et al., 2010)
The aim of this study is to evaluate and analyze the surgical outcome
for different surgical treatment modalities of craniopharyngiomas. The study
included the factors that may affect the prognosis and final functional
outcome such as age of the patient, tumor site, size, calcification,
hypothalamus involvement, extent of tumor, hydrocephalic, extent of tumor
excision, radiotherapy and tumor recurrence.
This study included thirty consecutive patients (15 male and 15 female)
aged between 1 and 51 years who were operated for intracranial
craniopharyngiomas that was proved histopathologically. These patients were
admitted and operated upon in neurosurgical department in Ain-shams
University hospital in the period between January 2006 and December 2008.
Patients were subjected to clinical assessment; through history taking, general
and neurological examination; and laboratory and radiological investigations.
Patients were treated with different surgical treatment modalities with the
median follow-up period of 37 months (range: 5 - 57 months).
Summary
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Thirteen patients (43.3%) were children and 17 patients (56.6%) were adults.
Headache and visual impairment were the most common presenting symptoms
(50% and 33.3% respectively), most of the patients (66.6%) had tumors medium in
size (between 2 and 4 cm). Calcification was seen in CT in 70% of patients. The
tumor appeared to be predominantly cystic and retrochiasmatic in 63.3% of
patients and 93.3% has extension into third ventricle as seen in MRI. Severe
preoperative hypothalamic involvement was identified in 56.6% of patients.
Hydrocephalus was found in 14 patients (46.6%). VP shunt was performed in
33.3% of patients. Gross total excision was done in 8 patients (26.6%), subtotal
excision in 7 (23.3%), partial excision in 9 (30%), biopsy in 2 (6.6%) while
stereotactic aspiration and Ommaya reservoir insertion was done in 4 patients
(13.3%).
Surgical treatment resulted in improvement of visual function in 36.6%, of
pituitary function in 20%, and in neurological improvement in 26.6% of patients.
Surgical morbidity in the form of visual deterioration happened in 10%, hormonal
disturbance in 83.3%, and neurological deficits in 20%. Hypothalamic affection
was evident in 10% of patients. Other postoperative complications were extradural
hematoma, wound infection and hydrocephalus in 16.6% of patients.
Fractionated external radiation therapy (in 11 patients) or Gamma knife
radiosurgery (in 8 patients) was performed in 63.3% of patients, and overall
recurrence rate after surgery and radiotherapy was documented a 33.3% of
patients.
The overall functional outcome was excellent in 4 patients (13.3), good
in 11 patients (36.3%), fair in 8 patients (26.6%), poor in 1 patient (3.3%),
and 6 patients (20%) died.
Preoperative visual and endocrinological state is the main deciding
factor of postoperative visual and endocrinological outcome. Factors
negatively affecting functional outcome include subtotal resection, young
age, tumor size ≥ 5 cm, tumor components, retrochiasmatic relation,
infiltration or displacement of the hypothalamus, multiple operations due to
tumor recurrence, huge calcification or presence of hydrocephalus.