PNA Medical Corner: Challenges in Craniopharyngioma Surgery
This month the PNA Medical Corner spotlights work done by PNA members Drs. Maria Koutouriousiou, Paul Gardner, and Juan Fernandez-Miranda.
A study featured in the Journal of Neurosurgical Science presents the advantages and limitations of transsellar/transtuberculum surgery for craniopharyngiomas. Coauthors include PNA members Juan Fernandez-Miranda, and Paul Gardner, along with colleauges Maria Koutourousiou, Eric Wang and Carl Snyderman. The UPMC group from the Department of Neurosurgery and the Department of Otolaryngology addresses potential contraindications of the approach in light of the proximity of this tumor to vital neurovascular structures often involving the pituitary stalk.
J Neurosurg Sci. 2018 Feb 23. doi: 10.23736/S0390-5616.18.04376-X. [Epub ahead of print]
Limits of transsellar/transtuberculum surgery for craniopharyngioma.
Koutourousiou M1, Fernandez-Miranda JC1, Wang EW2, Snyderman CH2, Gardner PA3.
1 Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
2 Departments of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
3 Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA - [email protected].
The proximity of craniopharyngiomas to vital neurovascular structures and their high recurrence rates make them one of the most challenging brain tumors to treat. Although surgery remains the first line of therapy and offers the best chance of radical resection and oncological cure, the high recurrence tendency of craniopharyngiomas, even after apparent total removal, often makes adjuvant treatment essential. The endoscopic endonasal approach (EEA) has been recently introduced as a treatment option for both pediatric and adult craniopharyngiomas, rapidly gaining wide acceptance over the traditional transcranial approaches. Although the primary role of EEA over traditional transcranial approaches has been slowly accepted in the literature, little has been written about the limitations and potential contraindications of this approach in the treatment of craniopharyngiomas. This article presents the advantages and highlights the limitations of endoscopic transsellar/transtuberculum surgery for craniopharyngiomas. In every case, surgery should be tailored to individuals based on their age and comorbidities, presenting symptoms, tumor characteristics, prior treatment and treatment tolerance, as well as the surgeon's preference based on personal experience and comfort.
|Dr. Paul Gardner||Dr. Juan Fernandez-Miranda|