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Infundibulo-tuberal or not strictly intraventricular craniopharyngioma: evidence for a major topographical category

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Abstract

Purpose

This study investigates retrospectively the clinical, neuroradiological, pathological and surgical evidence verifying the infundibulo-tuberal topography for craniopharyngiomas (CPs). Infundibulo-tuberal CPs represent a surgical challenge due to their close anatomical relationships with the hypothalamus. An accurate definition of this topographical category is essential in order to prevent any undue injury to vital diencephalic centres.

Methods

A systematic review of all scientific reports involving pathological, neuroradiological or surgical descriptions of either well-described individual cases or large series of CPs published in official journals and text books from 1892 to 2011 was carried out. A total of 1,232 documents providing pathological, surgical and/or neuroradiological evidence for the infundibulo-tuberal or hypothalamic location of CPs were finally analysed in this study.

Findings

For a total of 3,571 CPs included in 67 pathological, surgical or neuroradiological series, 1,494 CPs (42%) were classified as infundibulo-tuberal lesions. This topography was proved in the autopsy of 122 non-operated cases. The crucial morphological finding characterizing the tubero-infundibular topography was the replacement of the third ventricle floor by a lesion with a predominant intraventricular growth. This type of CP usually presents a circumferential band of tight adherence to the third ventricle floor remnants, formed by a functionless layer of rective gliosis of a variable thickness. After complete surgical removal of an infundibulo-tuberal CP, a wide defect or breach at the floor of the third ventricle is regularly observed both in the surgical field and on postoperative magnetic resonance imaging studies.

Conclusions

Infundibulo-tuberal CPs represent a major topographical category of lesions with a primary subpial development at the floor of the third ventricle. These lesions expand within the hypothalamus itself and subsequently occupy the third ventricle; consequently, they can be classified as not strictly intraventricular CPs. A tight attachment to the hypothalamus and remnants of the third ventricle floor is the pathological landmark of infundibulo-tuberal CPs.

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Acknowledgements

We especially thank Crystal Smith, Reference Librarian of the History of Medicine Department of the National Library of Medicine (NLM) at the National Intitutes of Health, Bethesda, MD, USA for her kind guidance and assistance at the National Library of Medicine during our process of search and review of the articles and monographs used in this study. We are also indebted to Lucretia MacLure and all the staff at The Francis Countway Medical Library at Harvard Medical School, Boston, MA, USA for their invaluable help in obtaining a considerable amount of the original research material used for this study. Finally, we want to thank George Hamilton for his critical review of language and style of the manuscript.

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Correspondence to José M. Pascual.

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Comment

This substantial piece of work makes a compelling case for a new classification of craniopharyngiomas. Whereas the “Not strictly intraventricular” name does not quite slip off the tongue, the concept will give those working in the field, particularly those adept in the extended endoscopic transsphenoidal procedure, some help in deciding on the radicality of their resection. Also to add a word of caution, as things stand, radiation techniques do continue to have a very major place in the management of these tumours. There is little mention of the role of this therapy here.

Michael Powell

London, UK

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Pascual, J.M., Prieto, R. & Carrasco, R. Infundibulo-tuberal or not strictly intraventricular craniopharyngioma: evidence for a major topographical category. Acta Neurochir 153, 2403–2426 (2011). https://doi.org/10.1007/s00701-011-1149-4

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