Herein, we report on an unusual case of craniopharyngioma arising in the temporal lobe with no prior history of surgery and with no connection to the craniopharyngeal duct. MR images showed a cystic tumor with a small solid portion. To the best of our knowledge, this is the first case of a craniopharyngioma occurring in the temporal lobe.
Adult ; Brain Neoplasms/diagnosis/*pathology/surgery ; Craniopharyngioma/diagnosis/*pathology/surgery ; Human ; Magnetic Resonance Imaging ; Male ; Temporal Lobe/*pathology/surgery

BACKGROUNDVarious surgical approaches for the removal of sellar region lesions have previously been described. This study aimed to evaluate the reliability and safety of the frontolateral approach (FLA) to remove sellar region lesions.

METHODSWe presented a retrospective study of 79 patients with sellar region lesions who were admitted and operated by the FLA approach from August 2011 to August 2015 in Department of Neurosurgery of Beijing Tian Tan Hospital. We classified FLA into three types, compared the FLA types to the areas of lesion invasion, and analyzed operation bleeding volume, gross total resection (GTR) rate, visual outcome, and mortality.

RESULTSSeventy-nine patients were followed up from 2.9 to 50.3 months with a mean follow-up of 20.5 months. There were 42 cases of meningiomas, 25 cases of craniopharyngiomas, and 12 cases of pituitary adenomas. The mean follow-up Karnofsky Performance Scale was 90.4. GTR was achieved in 75 patients (94.9%). Two patients (2.5%) had tumor recurrence. No patients died perioperatively or during short-term follow-up. Three patients (3.8%) with craniopharyngioma died 10, 12, and 23 months, respectively, after surgery. The operative bleeding volume of this study was no more than that of the other approaches in the sellar region (P = 0.783). In this study, 35 patients (44.3%) had visual improvement after surgery, 38 patients (48.1%) remained unchanged, and three patients' visual outcome (3.8%) worsened.

CONCLUSIONSFLA was an effective approach in the treatment of sellar region lesions with good preservation of visual function. FLA classification enabled tailored craniotomies for each patient according to the anatomic site of tumor invasion. This study found that FLA had similar outcomes to other surgical approaches of sellar region lesions.

Adult ; Craniopharyngioma ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; diagnosis ; surgery ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; surgery ; Retrospective Studies ; Skull Base ; pathology

BACKGROUNDCraniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.

METHODSFifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen, the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed.

RESULTSOf the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).

CONCLUSIONSMicrosurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.

Adolescent ; Adult ; Aged ; Cerebral Ventricle Neoplasms ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Craniopharyngioma ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant ; Male ; Microsurgery ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; pathology ; surgery ; Third Ventricle

We report a rare case of petroclival craniopharyngioma with no connection to the sellar or suprasellar region. MRI and CT images revealed a homogenously enhancing retroclival solid mass with aggressive skull base destruction, mimicking chordoma or aggressive sarcoma. However, there was no calcification or cystic change found in the mass. Here, we report the clinical features and radiographic investigation of this uncommon craniopharyngioma arising primarily in the petroclival region.
Cranial Fossa, Posterior/*pathology/radiography/surgery ; Craniopharyngioma/*diagnosis/radiography/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms/*diagnosis/radiography/surgery ; Skull Base Neoplasms/*diagnosis/radiography/surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the value of magnetic resonance three dimensional sampling perfection with application optimized contrasts using different flip angle evolution (3D-SPACE) sequences in diagnosis and surgical strategy modification for obstructive hydrocephalus.

METHODSFrom March 2013 to July 2014, there were 152 cases admitted in People's Liberation Army General Hospital suffered from hydrocephalus, including 88 male patients and 64 female patients aging from 8 months to 79 years. All patients were performed magnetic resonance T2WI and 3D-SPACE sequence scanning before operation. Surgical strategy was made after evaluation of 3D-SPACE sequence. Non-communicating hydrocephalus was treated with endoscopic third ventriculostomy (ETV) and communicating hydrocephalus was treated with ventriculo-peritoneal shunt. According to MR images of direct observation to site of obstruction to determine the detection rate. MRI 3D-SPACE and cranial CT examination were performed in regular follow-up studies.

RESULTSThe relevance ratio of 3D-SPACE for the diagnosis of non-communicating hydrocephalus was 98.3% (114/116), while the relevance ratio of conventional T2-weighted MRI was 72.4% (84/116). Among the 152 patients, there were 36 cases with cerebral aqueduct film obstruction, 22 cases with space-occupying lesions in pineal region, posterior part of the third ventricle, or space-occupying lesions in quadrigeminal bodies area, 10 cases with Dandy-Walker symptom, 18 cases with cyst of the anterior pool of the bridge, 16 cases with cysticercosis, 4 cases with cyst of lateral ventricle, 2 cases with cyst of fourth ventricle, 2 cases with space-occupying lesion in foramen ofmonro, 2 cases with foramen ofmonro atresia, 4 cases with craniopharyngioma, 36 cases with communicating hydrocephalus. There were 112 hydrocephalus cases (73.7%) were treated with ETV, without shunt catheter insertion in follow-up study from 1 to 18 months (average (14±9) months).

CONCLUSIONSFor obstructive hydrocephalus, MRI 3D-SPACE sequence image has high diagnostic yield rate for providing more detailed anatomical information than conventional MRI. Hence, the advanced imaging methods are helpful for surgical treatment strategy decision making.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Craniopharyngioma ; pathology ; Cysts ; pathology ; Female ; Follow-Up Studies ; Humans ; Hydrocephalus ; diagnosis ; surgery ; Imaging, Three-Dimensional ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pineal Gland ; pathology ; Third Ventricle ; Ventriculostomy ; Young Adult

OBJECTIVETo analyze the CT and magnetic resonance imaging (MRI) findings of craniopharygioma and explore the correlation between the pathological findings and clinical features of the disease.

METHODSThe CT and MRI findings of 123 pathologically confirmed craniopharygioma cases were reviewed retrospectively in conjunction with the pathological findings and surgical data.

RESULTSThis patient cohort consisted of 70 male and 53 female patients with their age ranging from 1 to 72 years (mean 23.82 years). Of the 123 craniopharyngioma patients, 59 were found to have adamantinous craniopharyngiomas, 41 had papillary squamous craniopharyngiomas, and 23 had mixed tumors. Solid tumor was found in 18 cases, cystic tumor in 38 cases, and calcification in 78 cases; in 23 cases, the posterior of the tumor did not exhibit clear boundary from the wall of the three cerebral ventricles, and in 11 cases CT and MRI displayed hypophysial stalk, which was found intraoperatively in 53 cases.

CONCLUSIONSMRI allows clear vision of the range of craniopharyngioma involvement and the anatomical structures surrounding the tumor. CT, on the other hand, shows better performance in displaying the calcification foci. Accurate identification of the site, dimension, calcification patterns and relation between the hypophysial stalk and hypothalamus by the imaging modalities significantly benefits the optimization of the surgical plan for the tumor.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cohort Studies ; Craniopharyngioma ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult