Repeat operations in pediatric patients with recurrent craniopharyngiomas. 2009

Woo Young Jang, and Kwan-Sung Lee, and Byung Chul Son, and Sin-Soo Jeun, and Yong-Kil Hong, and Sang Won Lee, and Seung-Ho Yang
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.

BACKGROUND Controversy continues over the optimal management of recurrent craniopharyngiomas. Our strategy for approaching repeatedly recurrent craniopharyngiomas in pediatric patients has been to decompress vital structures and relieve the symptoms as early as possible. The purpose of this study was to present our experiences of repeatedly recurrent craniopharyngiomas and the pattern of failure associated with treatment. METHODS A retrospective review was conducted on 7 pediatric patients who underwent resection >2 times in a single institution between 1990 and 2004. Resections were performed 3-8 times for each patient. Variables including tumor size, consistency and location, extent of resection, adjuvant therapy and morbidity were evaluated. RESULTS Thirty-two operations were performed in 7 pediatric patients. Total resection was not achieved by the third surgery and thereafter, and the interval between each surgery became shorter. Appetite disorders, neurocognitive disorders and behavioral disorders occurred following repeat surgeries. CONCLUSIONS Repeat operations are associated with a high failure rate of tumor control, even though they can help relieve neurologic symptoms. It is suggested that the number of repeat operations should be limited.

UI MeSH Term Description Entries
D008297 Male Males
D009361 Neoplasm Invasiveness Ability of neoplasms to infiltrate and actively destroy surrounding tissue. Invasiveness, Neoplasm,Neoplasm Invasion,Invasion, Neoplasm
D009367 Neoplasm Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Cancer Staging,Staging, Neoplasm,Tumor Staging,TNM Classification,TNM Staging,TNM Staging System,Classification, TNM,Classifications, TNM,Staging System, TNM,Staging Systems, TNM,Staging, Cancer,Staging, TNM,Staging, Tumor,System, TNM Staging,Systems, TNM Staging,TNM Classifications,TNM Staging Systems
D010911 Pituitary Neoplasms Neoplasms which arise from or metastasize to the PITUITARY GLAND. The majority of pituitary neoplasms are adenomas, which are divided into non-secreting and secreting forms. Hormone producing forms are further classified by the type of hormone they secrete. Pituitary adenomas may also be characterized by their staining properties (see ADENOMA, BASOPHIL; ADENOMA, ACIDOPHIL; and ADENOMA, CHROMOPHOBE). Pituitary tumors may compress adjacent structures, including the HYPOTHALAMUS, several CRANIAL NERVES, and the OPTIC CHIASM. Chiasmal compression may result in bitemporal HEMIANOPSIA. Pituitary Cancer,Cancer of Pituitary,Cancer of the Pituitary,Pituitary Adenoma,Pituitary Carcinoma,Pituitary Tumors,Adenoma, Pituitary,Adenomas, Pituitary,Cancer, Pituitary,Cancers, Pituitary,Carcinoma, Pituitary,Carcinomas, Pituitary,Neoplasm, Pituitary,Neoplasms, Pituitary,Pituitary Adenomas,Pituitary Cancers,Pituitary Carcinomas,Pituitary Neoplasm,Pituitary Tumor,Tumor, Pituitary,Tumors, Pituitary
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003397 Craniopharyngioma A benign pituitary-region neoplasm that originates from Rathke's pouch. The two major histologic and clinical subtypes are adamantinous (or classical) craniopharyngioma and papillary craniopharyngioma. The adamantinous form presents in children and adolescents as an expanding cystic lesion in the pituitary region. The cystic cavity is filled with a black viscous substance and histologically the tumor is composed of adamantinomatous epithelium and areas of calcification and necrosis. Papillary craniopharyngiomas occur in adults, and histologically feature a squamous epithelium with papillations. (From Joynt, Clinical Neurology, 1998, Ch14, p50) Craniopharyngioma, Adamantinous,Craniopharyngioma, Papillary,Rathke Pouch Tumor,Craniopharyngioma, Adult,Craniopharyngioma, Child,Neoplasm, Rathke Cleft,Neoplasm, Rathke's Cleft,Rathke Cleft Neoplasm,Rathke's Cleft Neoplasm,Rathke's Pouch Tumor,Adamantinous Craniopharyngioma,Adamantinous Craniopharyngiomas,Adult Craniopharyngioma,Adult Craniopharyngiomas,Child Craniopharyngioma,Child Craniopharyngiomas,Craniopharyngiomas,Craniopharyngiomas, Adamantinous,Craniopharyngiomas, Adult,Craniopharyngiomas, Child,Craniopharyngiomas, Papillary,Neoplasm, Rathkes Cleft,Papillary Craniopharyngioma,Papillary Craniopharyngiomas,Rathkes Cleft Neoplasm,Rathkes Pouch Tumor,Tumor, Rathke Pouch,Tumor, Rathke's Pouch
D003399 Craniotomy Surgical incision into the cranium. Craniectomy,Craniectomies,Craniotomies
D005260 Female Females

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