12 Years delayed postoperative spinal recurrence of craniopharyngioma. Case report and literature review.

A case of delayed spinal adamantinomatous craniopharyngioma recurrence is presented. A 54-year-old male patient was admitted in our Emergency Department complaining of urinary disorders and leg pains. He underwent surgical removal of intraventricular craniopharyngioma 12 years previously. On MR imaging a well-circumscribed intradural cistyc mass at the T12 level was reavealed. A T11 and T12 laminotomy was performed and total removal of the tumour was achieved. Histology examination showed adamantinous craniopharyngioma. The authors believe that this represents the third case described of spinal craniofaryngioma recurrence and the first involving the dorsal spine.

Early Ectopic Recurrence of Craniopharyngioma in the Cerebellopontine Angle.

Ectopic recurrence of craniopharyngioma in the cerebellopontine angle after surgical resection of a suprasellar craniopharyngioma is rare. Thus, only 5 cases were reported with a delay ranging between 4 and 26 years after removal of the primary tumor. We report a unique case of ectopic recurrence of craniopharyngioma in the cerebellopontine angle, which occurred at only 4 months after surgical resection of the primary tumor. A 24-year-old man underwent resection of a suprasellar craniopharyngioma via a right pterional approach four months earlier. During follow-up, cerebral magnetic resonance imaging (MRI) showed a round homogeneous contrast-enhancing tumor in the right cerebellopontine angle with neither relation to the internal auditory canal nor to the dura mater. After microsurgical resection, histopathological findings revealed ectopic recurrence of craniopharyngioma with similar tumors like the primary tumor. Although infrequent, craniopharyngioma may disseminate via the cerebrospinal fluid during surgical resection and grow in an ectopic place. Early follow-up and MRI scan following resection of a craniopharyngioma is recommended.

Postoperative spinal recurrence of craniopharyngioma.

PURPOSE: Remote recurrence of craniopharyngioma is an unusual postoperative complication. It occurs either along a previous surgical route or by seeding via cerebrospinal fluid (CSF). METHODS: A 49-year-old male had been operated on twice for a suprasellar craniopharyngioma in September 1999 and February 2003. From August 2003, he noted progressive low-back pain followed by ischialgia along the right S1 dermatome, which was symptomatic of an intradural tumor at the level of the first sacral segment. RESULTS: Total resection was performed and the tumor was histologically confirmed to be an adamantinomatous craniopharyngioma. CONCLUSIONS: We report the first case of remote spinal recurrence of adamantinomatous craniopharyngioma. No growth hormone therapy was administered to this patient. One must bear in mind this rare complication in craniopharyngioma patients and underline the importance of long-term follow-up.

Postoperative intracranial seeding of craniopharyngiomas--report of three cases and review of the literature.

PURPOSE: Seeding of craniopharyngioma has been rarely reported. We present three cases that ectopically recurred with seeding along the surgical route and CSF spaces. METHODS: The first patient was a 13-year-old boy who had initially undergone radical excision of a suprasellar and retrosellar craniopharyngioma by a right pterional approach. Postoperative MRI showed no evidence of residual tumor. Two years later, MRI revealed a local recurrence and in addition a separated cystic tumor on the right side adjacent to the middle cerebral artery consistent with seeding along the surgical route. Both tumors were removed by re-operation. On histopathological examination, both, the local recurrent tumor and the distant deposit turned out to be adamantinomatous craniopharyngiomas. The second patient was a 27-year-old woman who was operated on for the first time via a right pterional and 1 year later for a recurrent craniopharyngioma via a transsphenoidal approach. Two years later, MRI revealed a right fronto-lateral intracranial metastasis at the site of the former craniotomy, which was removed by re-craniotomy. This deposit in the operative pathway was found to be an adamantinomatous craniopharyngioma, as was the initial tumor. The third patient was a 42-year-old man who was operated on 10 years ago for the first time via a right fronto-temporal approach. The recent control MRT revealed a right parietal intracranial tumor with peripheral contrast enhancement, which was located distant to the former craniotomy. The tumor was removed and histopathological examination revealed an adamantinomatous craniopharyngioma in accordance with the initial tumor. Postoperatively, the three patients were neurologically intact. CONCLUSION: Although craniopharyngiomas exhibit a benign histopathological pattern, cerebrospinal fluid seeding along the surgical route or along the CSF pathways has been observed. Ectopic recurrence of craniopharyngioma suggests that meticulous protection of the whole surgical field and careful handling of the tumor during the operation are required. It should be emphasized that long-term follow-up is mandatory, even in patients undergoing a total removal.

Ectopic recurrence of craniopharyngioma along the surgical route: case report and literature review.

We present a 22-year-old woman with an ectopic recurrence of a craniopharyngioma. The patient presented first with a visual field deficit, and a craniopharyngioma was removed via an interhemispheric transcallosal approach. Magnetic resonance imaging (MRI) performed at 1 month, and then at 1 year after surgery showed complete removal of the lesion. However, at 4 years, MRI showed the presence of a small tumor in the right medial frontal lobe attached to the falx and along the previous surgical route. We present possible explanations for the ectopic recurrence and literature review.

Post-operative implantation metastasis of craniopharyngioma: a case report.

Craniopharyngiomas are histologically benign epithelial tumours arising from squamous epithelial remnants of Rathke's pouch, which have a tendency to invade surrounding structures and recur after apparently complete resection. They represent the most frequent non-glial tumour in children, accounting for approximately 5% of paediatric brain neoplasms. Total resection of a craniopharyngioma may be difficult, and recurrence has been reported in 25-70% of patients. Recurrence often occurs at the primary site, although a few cases of ectopic recurrence along surgical or needle tracts have been reported. Here a case of metastatic adamantinomatous-type craniopharyngioma attributed to direct implantation by surgical procedure is presented, along with a review of the current literature on craniopharyngiomas.

Surgical treatment of ectopic recurrence of craniopharyngioma. Report of 4 cases.

Local recurrence following radical resection is one of the most common complications of pediatric craniopharyngioma. Only 28 cases of ectopic recurrence of craniopharyngioma have been reported in the literature, and only 13 cases occurred in patients originally treated as children. In this consecutive series of 86 children who underwent radical resection of primary and recurrent craniopharyngiomas, 4 patients (4.7%) experienced ectopic tumor recurrence, accounting for 27% of all recurrences after gross-total resection. The authors report on the successful surgical treatment of these 4 patients and the impact of ectopic craniopharyngioma recurrence on survival.

[Value of 18F-FDG and 11C-MET PET-CT in differentiation of brain ringlike-enhanced neoplastic and non-neoplastic lesions on MRI imaging].

OBJECTIVE: To evaluate the value of (18)F-FDG and (11)C-MET PET-CT scan in differentiation of brain ringlike-enhanced lesions on MRI imaging. METHODS: Forty-one brain ringlike-enhanced lesions on MRI imaging including 30 brain tumors and 11 non-neoplastic lesions confirmed pathologically or clinically underwent (18)F-FDG and (11)C-MET PET-CT brain scan. Among them, 15 patients who were suspected to have brain metastasis received body scan by (18)F-FDG PET-CT. Both images were analyzed visually and semi-quantitatively. RESULTS: Visual analysis: for brain tumors the diagnostic sensitivity, specificity and accuracy of (18)F-FDG PET-CT was 53.3%, 72.7%, 58.5%, versus 96.7%, 90.9%, 95.1% of (11)C-MET PET-CT, respectively. All the primary foci in 9 patients with brain metastases were detected by body (18)F-FDG PET-CT scan. Semiquantitative analysis: There was a significant difference in the uptake between highly differentiated malignant and poorly differentiated tumors as well as non-neoplastic lesions for both tracers (P < 0.01), while between low-grade malignant tumors and non-neoplasm lesions, there was a difference in uptake only by (11)C-MET (P < 0.01). No significant difference between the uptakes in brain metastasis and glioblastomas was found by both tracers (P > 0.05). CONCLUSION: Both (18)F-FDG and (11)C-MET PET-CT are useful in differentiation of brain ringlike-enhanced lesions on MRI imaging. (11)C-MET PET-CT is more helpful than (18)F-FDG PET-CT in differential diagnosis of low-grade neoplastic from non-neoplastic lesions. Combination of (18)F-FDG and (11)C-MET PET-CT scans can improve the accuracy of differential diagnosis for brain ringlike-enhanced lesions on MRI imaging.

Metastatic craniopharyngioma: case report and literature review.

BACKGROUND: Distant spread of craniopharyngioma is a rare but important complication. Most cases are a result of spread along the surgical path. We describe a rare case of metastatic leptomeningeal craniopharyngioma as a result of dissemination along CSF pathways in a child. A review of previously described cases is provided. CASE PRESENTATION: A 14-year-old male was diagnosed with metastatic craniopharyngioma on routine follow-up imaging after multiple surgeries and radiation for locally recurrent craniopharyngioma. The lesion was erosive through the right parietal bone, but had remained clinically silent. The lesion was distant from previous surgical paths. The patient underwent right parietal craniotomy and resection of the lesion. Duraplasty and cranioplasty were necessary for closure. Histopathology confirmed adamantinomatous craniopharyngioma. One-year follow-up demonstrated no recurrence. DISCUSSION: A review of reported cases suggests that leptomeningeal implantation may be an important step in metastases of craniopharyngioma, although the mechanism is poorly understood. Attention to tumor spillage at the time of surgery may be important in preventing distant recurrences.

Cortical seeding of a craniopharyngioma after craniotomy: Case report.

BACKGROUND: Cortical seeding of a craniopharyngioma has been rarely reported. We present a case that ectopically recurred along the tract of a previous surgical route. METHODS: A 27-year-old woman presented earlier with a suprasellar craniopharyngioma. A left frontotemporal craniotomy was done with subtotal resection of the tumor because it was strongly adhered to the optic chiasm. Histopathology confirmed the diagnosis of craniopharyngioma. Six months after, the patient presented with decreased visual acuity and diplopia. She was reoperated through the previous craniotomy with a total resection. One year after the second surgery, the patient presented with seizures that were difficult to control. Magnetic resonance imaging revealed a contrast-enhancing tumor with cystic and solid components on the left temporal lobe cortex. The primary tumor bed was intact. The patient was reoperated, and the temporal lobe tumor was totally removed. Histologic studies showed an adamantinomatous craniopharyngioma. The patient was free of neurologic abnormalities, and no new lesion was found in the magnetic resonance imaging performed 1 year after the last surgery. CONCLUSIONS: Although craniopharyngiomas exhibit a benign histopathologic pattern, a total resection combined with careful inspection and irrigation of the surgical field is the optimal treatment for preventing local and ectopic recurrences. It is strongly recommended that the concerned patients have a long-term clinical and neuroimaging follow-up.

Ectopic recurrences of craniopharyngioma.

BACKGROUND: Ectopic recurrences of craniopharyngioma after total surgical removal are a rare event. Two possible mechanisms of seeding have been proposed: the dissemination of tumoral cells during the surgical procedure would account for tumor recurrence along the surgical path, whereas the migration of tumoral cells through the subarachnoid or Virchow-Robin spaces would explain ectopic recurrences far from the surgical bed or within the brain parenchyma. CASE REPORT: We report a unique case of metastatic craniopharyngioma recurring in a child after different intervals in which both the mechanisms could have taken place. The first ectopic seeding arose along the operative track of the primary surgical procedure in the frontal region while the second involved the deep cerebral nuclei and the brain stem. OUTCOME: The first recurrence was successfully operated upon. The following recurrences were not operated upon but remained stable for the last 4 years, thus showing dissociation between the capacity of seeding and invasivity.

Multiple intracranial seeding of craniopharyngioma after repeated surgery--case report.

A 17-year-old woman presented with a rare case of intracranial seeding of craniopharyngioma after repeated surgery. She initially presented with secondary amenorrhea and visual impairment. Magnetic resonance imaging revealed a suprasellar mass. Subtotal removal of the tumor was performed. The diagnosis was adamantinomatous craniopharyngioma. Seven months later, the patient underwent a second operation for recurrence of the craniopharyngioma. Subsequently, ventriculoperitoneal (VP) shunting and gamma knife surgery were performed. Twenty-seven months after the first operation, multiple cystic lesions were found in the right frontal and temporal lobes. Positive tumor cytology was observed in the cerebrospinal fluid obtained from the VP shunt chamber. These tumors were subtotally resected. However, the patient died from consecutive tumor recurrence 4 years after the initial diagnosis.

Metastatic papillary craniopharyngioma: case study and study of tumor angiogenesis.

We report a case of suprasellar papillary craniopharyngioma metastatic to the temporoparietal region 2 years after its initial resection. The literature documents examples of craniopharyngioma recurrences along the surgical tract, as well as remote ipsi- and contralateral metastases via cerebrospinal fluid seeding. Ours is the second report of a craniopharyngioma of papillary type to exhibit metastatic behavior. The tumor spread opposite the side of craniotomy. Although a rare occurrence, it confirms the limited capacity of histologically benign craniopharyngiomas to undergo meningeal seeding, likely the result of surgical manipulation. Immunohistochemical demonstration of increased microvascular density and vascular endothelial growth factor expression, as well as a high vascular endothelial growth receptor (VEGFR2) signal by in situ hybridization, suggests that tumor vascularity facilitated angiogenesis and may have been involved in the establishment and growth of the metastatic deposit.

Does craniopharyngioma metastasize? Case report and review of the literature.

OBJECTIVE AND IMPORTANCE: A rare case of recurrent craniopharyngioma at an ectopic location is described. This recurrence suggested cerebrospinal fluid seeding. CLINICAL PRESENTATION: A 65-year-old man presented for follow-up of persisting visual field defect. He had undergone total resection of a suprasellar craniopharyngioma via a subfrontal approach 3 years before presentation. Recent magnetic resonance imaging scans revealed a contrast-enhancing tumor with cystic and solid components at the right temporal lobe. The primary tumor bed was intact. INTERVENTION: A temporal craniotomy was performed for total resection of the tumor. Intraoperative findings revealed that the recurrent tumor was anatomically unrelated to the previous surgical track. Histological studies of the tumor specimen demonstrated a benign craniopharyngioma. Cerebrospinal fluid spreading was suspected to be the sole route for the recurrence. CONCLUSION: The case presented here and a review of reports on remote recurrence of craniopharyngioma suggest that care is required during intraoperative handling of the tumor and that long-term follow-up should be performed even in patients whose primary tumor was resected completely.

Recurrent ectopic craniopharyngioma.

A 66-year-old woman developed an asymptomatic mass in the right frontal lobe 5 years after undergoing a right frontal craniotomy and removal of a craniopharyngioma. The mass progressively enlarged over the next 3 years, during which time it became multiloculated and partially cystic. Repeat craniotomy was performed 8 years after the original operation, at which time the mass was found to be an ectopic craniopharyngioma. The lesion probably resulted from seeding of tumour cells along the surgical tract at the time of the initial surgery.

Metastatic craniopharyngioma.

We report a unique case of metastatic craniopharyngioma. Initially, the patient had a right frontal craniotomy for resection of a suprasellar mass, which was determined to be an adamantinomatous craniopharyngioma. Seven years later, an MR study of the brain showed two peripheral enhancing lesions adjacent to the dura and contralateral to the craniotomy site. Pathologic examination again showed adamantinomatous craniopharyngioma. Although recurrence, both local and along surgical tracts due to implantation of craniopharyngioma tissue, has been reported, this case raises the possibility of meningeal seeding to remote sites.

Intracranial craniopharyngioma seeding following radical resection.

A rare case of intracranial seeding from a craniopharyngioma is presented. A 12-year-old boy underwent radical resection of a suprasellar craniopharyngioma 2 years previously. There had been no evidence of recurrence during follow-up. He became symptomatic 1 week prior to admission, when imaging showed a recurrent tumor. The metastatic, subfrontal craniopharyngioma was not anatomically connected to the suprasellar region, but originated from the floor of the anterior fossa along the former surgical approach. The significance of this finding and its relation to recurrent craniopharyngioma is discussed.

Remote recurrence of craniopharyngioma in the epidural space. Case report.

The case is reported of a 28-year-old man with "ectopic" craniopharyngioma recurring in the epidural space 21 years after the original tumor was resected. Previously described cases of similar remote recurrences as well as some features of the biological behavior of craniopharyngioma are discussed. The rarity of this postoperative complication is addressed.