Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1655  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,178 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed2079    
    Printed58    
    Emailed0    
    PDF Downloaded48    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 1  |  Page : 137-139

Ectopic recurrence of craniopharyngioma along the surgical tract


1 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
2 Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Date of Submission06-Oct-2010
Date of Decision07-Oct-2010
Date of Acceptance09-Oct-2010
Date of Web Publication18-Feb-2011

Correspondence Address:
Pravin Salunke
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.76881

Rights and Permissions



How to cite this article:
Salunke P, Bhardwaj LK, Gupta K, Das K. Ectopic recurrence of craniopharyngioma along the surgical tract. Neurol India 2011;59:137-9

How to cite this URL:
Salunke P, Bhardwaj LK, Gupta K, Das K. Ectopic recurrence of craniopharyngioma along the surgical tract. Neurol India [serial online] 2011 [cited 2019 Aug 22];59:137-9. Available from: http://www.neurologyindia.com/text.asp?2011/59/1/137/76881


Sir,

Craniopharyngiomas are considered as the most common non-glial intracranial tumours in children. In adults, they account for approximately 2%-4% of brain tumours. Although histologically craniopharyngiomas are benign tumours, they tend to locally infiltrate the surrounding neurovascular structures, making the complete excision challenging. [1]

A 5-year-old female child presented with left side weakness and right side progressive loss of vision of 3-month duration. Magnetic resonance imaging (MRI) showed suprasellar enhancing lesion, extending more on the right side [Figure 1]. She underwent a right frontotemporal craniotomy and near total excision. A branch of right anterior cerebral artery was inadvertently injured during surgery. Fortunately, the patient did not develop new deficits. Follow-up MRI at two months did not show any residual lesion [Figure 2]. Follow-up MRI after 11 months showed a cystic collection with enhancing wall in the right Sylvian fissure and another lesion along the stalk and suprasellar region with solid and cystic components [Figure 3]. However, she was asymptomatic. At redo-craniotomy, two cysts were seen in the Sylvian fissure. One cyst had straw-coloured fluid and gritty calcifications and total excision was done [Figure 4]. Another large cyst was present in the interoptic space and suprasellar region, which also had straw-coloured fluid and calcification and firm solid components. The entire solid component and wall of the cyst was peeled off the arachnoid along the stalk. Postoperatively, she developed diabetes insipidus, which required desmopressin. The follow-up MRI after six weeks showed no recurrence or residual lesion. Histopathology was suggestive of adamantinomatous variety of craniopharyngioma. The MIB index was low. We decided against radiotherapy, considering her age.
Figure 1a-c: Pre-operative contrast MRI showing a large suprasellar mass with extension to the right side, with solid and cystic components

Click here to view
Figure 2a-b: Post-operative MRI 3 months later showing no recurrence or residual lesion

Click here to view
Figure 3: Coronal contrast MRI post-operative 11 months later showing recurrence along the right Sylvian fissure and in the suprasellar region

Click here to view
Figure 4a-b: Intra-operative picture showing cystic lesion with gritty calcification in the wall, in lateral aspect of Sylvian fissure, and picture showing removal of the lesion from the Sylvian fissure, exposing both frontal and temporal branches of middle cerebral arteries

Click here to view


There are a few reports of ectopic recurrence of craniopharyngiomas, 26 cases till date, including our case. Local recurrence, as high as 25%-70%, has been reported. The most frequent mechanism of dissemination is seeding of tumour cells along the surgical route. During the resection, tumour cells may remain along the operative route and grow. However, the exact mechanisms or surgical techniques predisposing for the ectopic recurrences are unknown. The other proposed mechanism is spillage of tumour cells into the subarachnoid space. This mechanism can explain the ectopic recurrence in the posterior cranial fossa, supratentorial region unrelated to the surgical site and spine in the lumbar region. [1],[2],[3],[4] All ectopic recurrences have been reported in patients who had undergone tumour removal by transcranial approach and no case has been reported after removal by transsphenoidal approach. Literature suggests that even complete resection does not prevent ectopic recurrence. [2] The time between the initial presentation and evidence of ectopic recurrence has been variable and in the range of 1-21 years. [3] The histological characteristics of craniopharyngioma seem to have some bearing on the recurrence, both ectopic and local. The adamantinomatous type is associated with a worse post-operative outcome and has a greater risk for recurrence than the squamous papillary type. [4] Proliferative indices may predict local recurrence. However, its role in ectopic recurrence remains to be determined. [4]

Meticulous surgery with careful inspection of surgical field and abundant irrigation is one way to prevent ectopic recurrence. Post-operative radiotherapy, though controversial for patient with total resection, may be an option for preventing ectopic recurrence. Theoretically, radiotherapy can destroy residual tumour cells at the site of resection as well as microdeposits at different sites. [4] However, the ill-effects of radiotherapy should not be underestimated.

 
  References Top

1.Bikmaz K, Guerrero CA, Dammers R, Krisht AF, Husain MM. Ectopic recurrence of craniopharyngiomas: Case report. Neurosurgery 2009;64:E382-3  Back to cited text no. 1
    
2.Romani R, Niemelä M, Celik O, Isarakul P, Paetau A, Hernesniemi J. Ectopic recurrence of craniopharyngioma along the surgical route: Case report and literature review. Acta Neurochir (Wien) 2010;152:297-302   Back to cited text no. 2
    
3.Bianco Ade M, Madeira LV, Rosemberg S, Shibata MK. Cortical seeding of a craniopharyngioma after craniotomy: Case report. Surg Neurol 2006;66:437-40.   Back to cited text no. 3
    
4.Jeong IH, Lee JK, Moon KS, Joo SP, Kwak HJ, Kim TS, et al. Ectopic recurrence of craniopharyngioma: A case report and review of the literature. J Neurooncol 2006;79:191-5.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow