Abstract
BackgroundCerebral infarction (CI) is a known vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP).MethodsMRI of 244 CP patients, recruited between 2007 and 2019 in KRANIOPHARYNGEOM 2007, were reviewed for CI. Risk factors for CI and outcome after CI were analyzed.ResultsTwenty-eight of 244 patients (11%) presented with CI based on reference assessment of MRI. One CI occurred before initial surgery and one case of CI occurred after release of intracystic pressure by a cyst catheter. 26 of 28 CI were detected after surgical tumor resection at a median postoperative interval of one day (range: 0.5-53 days). Vascular lesions during surgical procedures were documented in 7 cases with CI. No relevant differences with regard to surgical approaches were found. In all 12 irradiated patients, CI occurred before irradiation. Multivariable analyses showed that hydrocephalus and gross-total resection at the time of primary diagnosis/surgery both were risk factors for CI. After CI, quality of life (PEDQOL) and functional capacity (FMH) were impaired.ConclusionsCI occurs in 11% of surgically-treated CP cases. Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI.
Highlights
Childhood-onset, adamantinomatous craniopharyngiomas (CP) are rare embryonal malformational tumors, originating in the sellar and parasellar region with WHO grade I malignancy
Patients developing Cerebral infarction (CI) were comparable to patients without CI in terms of gender, age at CP diagnosis (Figure 2), body mass index (BMI), height standard deviation score (SDS), grade of hypothalamic involvement (HI) and tumor location at the time of CP diagnosis
CI was diagnosed before the start of irradiation (XRT)
Summary
Childhood-onset, adamantinomatous craniopharyngiomas (CP) are rare embryonal malformational tumors, originating in the sellar and parasellar region with WHO grade I malignancy. Long-term prognosis and quality of life (QOL) are frequently impaired due to sequelae caused by the anatomical location of CP close to the pituitary gland, the hypothalamus, Cerebral Infarction After Craniopharyngioma and the optic chiasm [1,2,3,4,5]. A 14% rate of cerebrovascular events has been reported by Regine et al [13], all in patients with CP who received irradiation doses >61 Gy. Cerebral infarction (CI) is a known vascular complication following treatment of suprasellar tumors. Risk factors for CI, incidence rate, and long-term prognosis are unknown for patients with childhood-onset craniopharyngioma (CP). Degree of resection and increased intracranial pressure are risk factors, which should be considered in the planning of surgical procedures for prevention of CI
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