Pathological and Clinical Basis of the Indications for Treatment of Craniopharyngiomas

Abstract

Pathological and clinical studies were performed concerning the indications of operative treatment for craniopharyngiomas with seven autopsied brains and 15 cases which had been treated by extensive removal of the tumor. From the present study, it could be concluded that the total removal of the tumor was not always possible without potential neuroendocrinological deficits. The pathological basis is that the tumor cells invaded adjacent brain structures as fingershaped or island-like protrusions without significant glial cleavage and with close approximation to the neurons of the micron order in some cases, while in the other cases, a thicker layer of gliosis including Rosenthal fibers and fibrillary astrocytes existed between the tumor and neuronal structures. From the clinical study, the risk factors in the indication of extensive removal of craniopharyngioma could be correlated with the prognosis. These factors are the size and the location of the tumor, the existence of diabetes insipidus and psychiatric signs, and more significantly an irregular defect in the floor of the third ventricle.