title: Intraventricular craniopharyngiomas: surgical management and outcome analyses in 24 cases.
abstract: OBJECTIVE
  Pure intraventricular craniopharyngioma is a rare subtype of craniopharyngioma that attaches frequently to the hypothalamus. The main challenge in tumor removal is protection of hypothalamic structure. The aim of our study was to set up a feasible risk-evaluation approach to help the surgeons make an individual treatment plan.
  
  
  METHODS
  We reviewed retrospectively 24 patients with pure intraventricular craniopharyngioma who underwent surgical therapy. Third ventricular deformation and thalamic attachment of the tumor were assessed by preoperative magnetic resonance imaging and intraoperative inspection. Correlations between the outcome, extent of removal, and different attachment grades were analyzed.
  
  
  RESULTS
  Preoperative magnetic resonance imaging grade had a significant correlation with functional outcome. Attachment grade was significantly correlated with endocrine, functional, and radiologic outcome. In the gross total removal (GTR) group, significantly more newly developed endocrinologic deficits were observed compared with patients who underwent subtotal removal (STR). All 6 GTR cases with the greatest attachment grade (grade 2) acquired newly developed endocrine insufficiency.
  
  
  CONCLUSIONS
  Attachment and deformation grade evaluated based on our criteria are significantly correlated with postoperative outcome. GTR of tightly attached tumor is associated with worse endocrinologic, functional, and radiologic outcomes compared with STR. Hence, we suggest that individual surgical plans should be made according to the grade of tumor attachment and hypothalamic deformation. STR should used in tumors with a high grade to achieve a good long-term outcome and avoid severe postoperative sequelae.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yu
authors.affiliation: Max-Planck-Institute of Experimental Medicine, Göttingen, Germany.
authors.forename: Xingwen
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Ren
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiangli
authors.initials: X
authors.lastname: Cui
authors.affiliation: Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China.
authors.forename: Junmei
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: linsong2005@126.com.
authors.forename: Song
authors.initials: S
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management; D002551:Cerebral Ventricle Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003397:Craniopharyngioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006728:Hormones
keywords: Attachment grade; Extent of resection; Intraventricular craniopharyngiomas