• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.108-113
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• 2017

Craniopharyngiomas exhibiting histologic malignancy are extremely rare. Herein, we report the case of a 26-year-old male patient who underwent suprasellar mass excision via an interhemispheric transcallosal approach. Histopathological examination indicated that the craniopharyngioma was of the adamantinomatous subtype. The patient received postoperative medical treatment for endocrine dysfunction and diabetes mellitus without radiation treatment. Two years after the operation, he presented with progressive visual disturbance and altered mentality. Magnetic resonance imaging revealed a huge mass in the suprasellar cistern and third ventricle. He underwent a second operation via the same approach. The histopathological examination showed an adamantinomatous craniopharyngioma with sheets of solid proliferation in a spindled pattern, indicating malignant transformation. Malignant transformation of craniopharyngioma in the absence of radiation therapy has been reported in only five cases, including this one. We present a case of malignant transformation of craniopharyngioma with a brief review of relevant literature.

• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.535-537
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• 2011

Recently, combination of surgery and radiation therapy (RT) has been recommended in the treatment of craniopharyngioma. RT could be associated with late complications, including vasculopathy. We report two cases of the moyamoya syndrome seen in children with craniopharyngioma who received RT after surgical resection. Thirty-five patients in pediatric age with craniopharyngioma were surgically treated. Fifteen out of 35 patients underwent surgical resection followed by RT or gamma knife surgery. Two of the 15 were found to have symptoms of transient ischemic attack and were diagnosed as moyamoya syndrome through the cerebral angiography. Age at RT was 4 and 13 years, respectively. The latent period for development of the moyamoya syndrome was 27 months and 3 years, respectively, after RT. The RT dose of both patients was 54 Gy. These two patients received bilateral encephaloduroarteriosynangiosis procedures. We report here these two cases of radiation-induced moyamoya syndrome in pediatric craniopharyngioma. Pediatric patients with craniopharyngioma who received RT should be reminded, during follow-up, about the risk of development of the moyamoya syndrome.

• Restorative Dentistry and Endodontics
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• v.26 no.2
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• pp.121-123
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• 2001

Idiopathic external root resorption is an apparently infrequently occurrence involving single or multiple teeth. Presented is an unusual case of multiple external root resorption associated with craniopharyngioma. Although the cause of this resorption was not determined, several possibilities are discussed. The literature to a systemic etiology for external root resorption is briefly reviewed.

• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1220-1223
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• 2001

Authors experienced a unique case of craniopharyngioma which had evolved rapidly after 4 years of total resection for supratentorial meningioma. A 58-year-old woman presented with headache and visual deterioration. Previously, she had undertaken surgical removal of frontal convexity meningioma 4 years ago and had been well without any postoperative sequelae thereafter. Brain magnetic resonance imaging demonstrated a newly developed suprasellar mass. Pertinent operative procedure was performed and histological verification was made as an adamantinomatous craniopharyngioma. She has been showing unremarkable clinical course up to date. Possible pathogenic mechanisms of de novo development of craniopharyngioma are disscussed with review of case.

• Investigative Magnetic Resonance Imaging
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• v.22 no.4
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• pp.249-253
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• 2018

Superficial siderosis of the central nervous system (CNS) is a progressive and debilitating neurological disease manifesting sensorineural hearing loss, cerebellar ataxia, and pyramidal tract signs. Chronic extravasation of blood into the subarachnoid space results in the accumulation of hemoglobin derivate in the subpial layer of the CNS, which is toxic to the neural tissues. Craniopharyngioma is a benign third ventricle tumor, which rarely presents with tumor bleeding. We report a rare case of superficial siderosis associated with craniopharyngioma with intratumoral hemorrhage in a patient with no history of prior trauma or CNS surgery.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.561-566
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• 2001

Objective : The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. Method : Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). Result : The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. Conclusion : GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.6-10
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• 2006

Objective : The purpose of this study is to evaluate the surgical outcomes of bifrontal interhemispheric[BIH] approach and compare them to those of the pterional approach for the treatment of craniopharyngioma. Methods : Seventeen patients had their first operation for the resection of craniopharyngiomas between 2000 and 2004 at our medical center. Eleven patients who had the pterional approach and 6 with the BIH approach were enrolled. The age range at the time of surgery was 5 to 80 years [mean age 35.6 years old]. The presenting symptoms were visual disturbance increased intracranial pressure in 5 patients. Results : The tumors were totally removed in 3 [27 %] and subtotally in 8 [73 %] patients with the pterional approach. Total tumor removal was achieved in 5 out of 6 [83%] patients by the BIH approach, except improved in 4 [36 %] patients treated with the pterional approach and in all patients treated by the BIH approach. Conclusion : The BIH approach for craniopharyngioma surgery may be an effective and safe approach for tumors that extend outside of the sellar-suprasellar region with acceptable outcomes.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.256-258
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• 2008

We report a rare case of symptomatic Rathke's cleft cyst with thick calcified wall. Brain CT scans revealed a large cystic mass with round thick calcified wall. In this case, we selected the pterional approach instead of transsphenoidal approach due to the possibility of cystic craniopharyngioma. Histopathologically, it was calcified Rathke's cleft cyst with focal epithelial metaplasia. This case illustrates that calcification of the suprasellar cyst does not always suggest craniopharyngioma and the calcification pattern of Rathke's cleft cyst is different from that of the craniopharyngioma.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.54-56
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• 2014

Intracranial tumors secondary to radiotherapy are rare. In this group gliomas are the rarest. Only 6 cases of glioblastoma multiforme (GBM) have been reported in patients undergoing radiotherapy (RT) for craniopharyngiomas of which only 4 have been in children less than 18 years of age. In recent years RT has become a mainstay of adjuvant therapy for recurrent or partially excised craniopharyngiomas. We report a child of 12 years who had previously undergone RT for a suprasellar craniopharyngioma and presented 10 years later with a GBM. This is the 5th pediatric case in literature demonstrating a GBM after RT for a craniopharyngioma. The implications of subjecting the pediatric population to RT for a benign lesion versus the outcome of gross total removal and management of RT induced tumors is discussed and the need to avail of safer alternatives such as stereotactic radiosurgery is stressed.

• Journal of Korean Neurosurgical Society
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• v.52 no.1
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• pp.37-41
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• 2012

Objective : The aim of this study was to describe a single center's experience in the management of craniopharyngiomas in children over a 15-year period. Methods : The clinical records of pediatric patients treated for craniopharyngiomas between December 1995 and February 2011 were reviewed. Thirty-five pediatric patients diagnosed with craniopharyngioma were treated, and their medical records and imaging data were analyzed retrospectively. Results : The mean follow-up duration was 76 months (range, 10-195). Overall survival and local control rates at 10 years were $94.7{\pm}5.1%$ and $37.1{\pm}11.9%$, respectively. The female-to-male ratio was 16 : 19, and the mean age was 8.6 years (range, 1-17). Initially, gross total resection (GTR) was performed in 30 patients; subtotal resection (STR) followed by radiotherapy was performed in 5 patients. Of the 14 cases that showed recurrence after GTR, 5 patients were treated with GTR, 1 with radiation therapy (RT), 4 with gamma knife radiosurgery (GKRS), and 4 with subtotal resection followed by RT. No patients who underwent RT or GKRS had recurrences. Two cases with recurrence after STR followed by RT were treated with GTR. One patient died of hormonal insufficiency 64 months after the first surgery. The overall median time progression was 51.2 months (range, 3-182) : 49.7 months in the patients who underwent GTR and 60.2 months in the patients who underwent STR followed by RT. Conclusion : If safe resection is possible, GTR at the initial treatment should be attempted to reduce the tumor recurrence. However, if the tumor recurs after the first surgery, RT or GKRS with/without reoperation may be an effective salvage treatment for recurrent craniopharyngioma.