Clinical Features of Craniopharyngioma With Tumoral Hemorrhage: A Retrospective Case-Controlled Study

Abstract

Background: Craniopharyngioma (CP) with tumoral hemorrhage is a very rare syndrome presenting with various manifestation and unfavorable outcomes. The current retrospective study was performed to summarize the clinical features of CP with tumoral hemorrhage.

Methods: In this study, 185 patients with pathological diagnosis of CP (18 patients with hemorrhage) were enrolled. Clinical characteristics, radiological and surgical treatments, and post-operative complications were analyzed. In addition, the correlations between sexual hormones and tumor volume were explored.

Results: Drowsiness, acute syndrome, and pituitary deficiency were more frequent in patients with hemorrhage patients. Prothrombin time (PT) were higher in patients with hemorrhage. Luteinizing hormone (LH) and testosterone (T) were lower in male patients with hemorrhage. Post-operative electrolyte disturbances, hypothalamic syndrome, and death appeared more frequently in the hemorrhage group. Moreover, prolactin (PRL) and cortisol 8AM were found to be correlated with the volume of the tumor and the hematoma, respectively.

Conclusion: The current study presented the clinical features of CP apoplexy from the aspects of clinical characteristics, radiography, surgical treatment, and post-operative complications. Patients with CP apoplexy could benefit from the proper processing of peritumoral hemorrhage and post-operative monitoring of the electrolyte.

Keywords: craniopharyngioma; endocrine; pituitary hormone; risk factor; tumoral hemorrhage.

Figure 1

Typical case illustration of craniopharyngioma (CP) with tumoral hemorrhage. Pre-(A,B) and post-operative (G,H) radiological images (axial CT and sagittal MRI) showed the hemorrhage around the lesion (A) and gross total resection (GTR) of the tumor. Intraoperative views of the tumor and hemorrhage around the tumor of Patient No. 2 were displayed as a typical case (C,D). Hemorrhage was labeled with a circle. Pathological diagnosis confirmed the tumor as suprasellar CP with tumoral hemorrhage [(E), HE, ×100; (F) HE, ×400). CP, craniopharyngioma; ICA, internal carotid artery; Op., optic nerve.

Figure 2

Selection of the region of interest (ROI) in the calculation of volumes of the tumor and the hematoma. The tumor (Left) or the hematoma (Right) area on each slice of the DICOM image was recognized and circumscribed (yellow circle) with the software.

Figure 3

Correlation between the tumor/ hematoma volumes and the hormones. (A) LH, (B) FSH, (C) PRL, (D) female E₂, (E) female P, (F) male T, and (G) Cortisol 8AM. E2, estradiol; FSH, follicle stimulating hormone; LH, luteinizing hormone; P, progesterone; PRL, prolactin; T, testosterone; Vhema, the volume of the hematoma; Vtumor, the volume of the tumor. The values of r and p of V tumor for hormones are: LH (r = −0.0313, p = 0.902), FSH (r = −0.2868, p = 0.249), PRL (r = −0.5114, p = 0.030), female E₂ (r = −0.3306, p = 0.522), female P (r = −0.3091, p = 0.551), male T (r = −0.2579, p = 0.418), and cortisol 8AM (r = 0.1223, p = 0.629). The r values and p of V hema for hormones are: LH (r = −0.2848, p = 0.252), FSH (r = −0.3831, p = 0.117), PRL (r = −0.3439, p = 0.162), female E₂ (r = −0.1999, p = 0.704), female P (r = −0.4386, P = 0.384), male T (r = −0.1151, p = 0.722), and cortisol 8AM (r = 0.5155, p = 0.029). Gray shadow and dotted curves represent the 95% confidence bands of the best-fit line for the volume of the tumor and the hematoma, respectively.