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  • Mammillary Body Angle as a Predictor of Endocrinological and Visual Postoperative Outcomes in Patients with Craniopharyngioma.

    Final Number:

    David Tiago Fernandes MD; Tomasz A Dziedzic MD, PhD; Eric Wang; Paul A. Gardner MD; Juan Carlos Fernandez-Miranda MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Pituitary dysfunction and visual field defects are potential complications following craniopharyngioma resection. Recently, the Mammillary Body Angle (MBA), defined as the intersection of a tangential plane to the base of the mammillary body with a plane tangential to the floor of the fourth ventricle, has been proposed to predict third ventricle involvement. Our aim is to evaluate the usefulness of MBA for third ventricle involvement to predict postoperative endocrinological and/or visual outcome.

    Methods: We performed retrospective review of 66 consecutive patients (48 adult and 18 children) diagnosed with craniopharyngioma that underwent Endoscopic Endonasal Surgery between 1999-2016 in a single institution. The MBA were measured on preoperative MRIs and was categorized into one of four groups: (I) <50º; (II) 50º–70º; (III) >70º and group (IV) MBA-not possible to evaluate. These results were correlated with postoperative outcomes.

    Results: In 62(94%) patients (45 adults and 17 children) it was possible to measure MBA preoperatively. Thirty (48%) patients were assigned to group (I), 11(18%) to (II), and 21(34%) to (III) and 4(6%) to (IV). Third ventricle invasion was intraoperatively confirmed in 26(39%) cases, 53% in group (I), 36% in (II), 9% in (II) and 100% of patients in group (IV). Preoperative visual impairment was more common in adults (89%) than in children (44%). Anterior pituitary dysfunction was the most common preoperative endocrine finding affecting 50% of patients on each group. Postoperative visual improvement was seen in 46(96%) adults and 16(94%) children regardless of the preoperative MBA. New postoperative endocrine dysfunction was seen in 20 adults, 100% in group (IV) 75% in (I), 66% (II) and 54% (III); and in 9 children, 46% (III), 34% (II), 25% (I) and 0 in group (IV).

    Conclusions: Lower and non-identifiable MBA are related with third ventricle involvement and increased risk of postoperative pituitary dysfunction, but has not relationship with visual outcome.

    Patient Care: Knowing which patient population are at higher risk of developing postoperative endocrine dysfunction or visual field defect after endoscopic endonasal resection of craniopharyngioma, could help in creating new strategies to improve patient outcome.

    Learning Objectives: -Reliability of Mamillary body angle (MBA) for third ventricle involvement. -Application of MBA for postoperative outcome prediction. -Identify MBA with the highest risk of postoperative endocrine dysfunction. -Identify MBA with the highest risk of postoperative visual fields defect. -Differences in outcome on adults and children.

    References: 1. Fernandez-Miranda JC, Gardner PA, Snyderman CH, et al. Craniopharyngioma: a pathologic, clinical, and surgical review. Head Neck. Jul 2012;34(7):1036-1044. 2. Turel MK, Tsermoulas G, Gonen L, et al. Management and outcome of recurrent adult craniopharyngiomas: an analysis of 42 cases with long-term follow-up. Neurosurg Focus. Dec 2016;41(6):E11. 3. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg. Apr 2008;108(4):715-728. 4. Hoffman HJ. Surgical management of craniopharyngioma. Pediatr Neurosurg. 1994;21 Suppl 1:44-49. 5. Steno J, Malacek M, Bizik I. Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery. May 2004;54(5):1051-1058; discussion 1058-1060. 6. Wang KC, Kim SK, Choe G, Chi JG, Cho BK. Growth patterns of craniopharyngioma in children: role of the diaphragm sellae and its surgical implication. Surg Neurol. Jan 2002;57(1):25-33. 7. Pascual JM, Prieto R, Carrasco R, Barrios L. Displacement of mammillary bodies by craniopharyngiomas involving the third ventricle: surgical-MRI correlation and use in topographical diagnosis. J Neurosurg. Aug 2013;119(2):381-405. 8. Stefko ST, Snyderman C, Fernandez-Miranda J, et al. Visual Outcomes after Endoscopic Endonasal Approach for Craniopharyngioma: The Pittsburgh Experience. J Neurol Surg B Skull Base. Aug 2016;77(4):326-332.

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