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This volume focuses on adult craniopharyngiomas, offering various perspectives. The first part of the book provides an up-to-date overview of the pathogenesis and management of adult craniopharyngiomas, helping readers understand the pathogenesis and molecular pathways. It highlights the importance of animal models for addressing molecular keys and for developing targeted therapies. The second part deals with clinical management, detailing the latest results in the era of endoscopic surgery, including the major contribution of the extended nasal endoscopic approaches for suprasellar and retrochiasmatic tumors. The book also discusses the key aspects of these tumors and how to manage them. The last part of the book addresses the future therapies and recurrences after surgery and radiotherapy. This volume is of interest to neurosurgeons, endocrinologists, paediatricians, radiologists and oncologists.
Craniopharyngiomas are a type of brain tumour in the suprasellar region with benign histological and cellular features. Clinical manifestations of craniopharyngiomas include decreased vision, hypopituitarism, hypothalamus dysfunction, fluid and electrolyte imbalance, glycometabolism, lipid metabolism and obesity. Craniopharyngiomas can show some characteristics of malignant tumours, such as invasion to the surrounding tissues, repetitious recurrence, and rapid growth. These characteristics cause considerable difficulty in patient treatment for neurosurgeons all over the world. This volume presents detailed information about craniopharyngioma anatomy, classification and treatment.
This book is a practical, up-to-date guide to the treatment of patients with brain and spinal tumors. Leading experts in the field explain treatment techniques in detail, highlighting key considerations in the use of external beam radiation therapy, intensity-modulated radiation therapy, particle therapy, radiosurgery, and stereotactic body radiation therapy. Specific recommendations are described for different tumor types, and helpful information provided on other important issues, such as the interaction of radiotherapy and systemic therapy and the avoidance of treatment complications. With the development of modern technology, highly conformal radiotherapy techniques have become more complicated, yet also more widely employed. This book will equip readers with the knowledge required to set up practices to deliver quality brain and spinal radiation therapy appropriate to each patient. It will be of benefit to radiation oncologists, clinical oncologists, medical physicists, medical dosimetrists, radiation therapists, and senior nurses as well as medical oncologists and surgical oncologists with an interest in radiotherapy.
This astute volume brings together the latest expert research on adamantinomatous craniopharyngiomas (ACPs). ACPs are histologically benign but clinically aggressive tumors exhibiting a high propensity for local invasion into the hypothalamus, optic and vascular structures. These tumors, as well as the current treatments, may result in pan-hypopituitarism, diabetes insipidus, morbid obesity followed by type II diabetes mellitus, blindness, as well as serious behavioral and psychosocial impairments. Exploring in detail advances in both the understanding of tumor biology as well as clinical advances in patient management are explored in detail, this book will also look towards potential new treatment approaches. Basic Research and Clinical Aspects of Adamantinomatous Craniopharyngioma is the first book compiling all current research on ACPs. Mouse and human studies have unequivocally demonstrated that mutations in CTNNB1 encoding -catenin underlie the etiology of the majority, if not all ACP tumors. Genetic studies in mice have shown that ACPs are tumors of the pituitary gland and not of the hypothalamus as previously thought, and are derived from Rathke’s pouch precursors. In addition, a role for tissue-specific adult pituitary stem cells has been revealed as causative of ACP. Together, these studies have provided novel insights into the molecular and cellular etiology as well as the pathogenesis of human ACP. Finally, this volume covers new treatment approaches that have been shown to be effective both in reducing ACP burden as well as reducing the morbidity associated with therapy.
It has been known for over 40 years that GH-deficient-children benefit from replacement with the hormone. But GH, essential for longitudinal growth, also plays a role after completion of final height. With the introduction of biosynthetic human GH 20 years ago, the use of GH was no longer restricted to severe growth retardation in hypopituitary children. This book will take the reader behind the myths of GH and into the real world of clinical endocrinology. The contributions stem from recognized clinicians and scientists who have been working in the field for decades. The contents encompass traditional end points of GH therapy such as body composition, bone biology and physical performance. Attention is also devoted to diagnostic aspects and side effects. Additional features range from clinical epidemiology to quality of life, and novel areas such as the impact of traumatic brain injury on pituitary function are also covered. The present volume of Frontiers of Hormone Research is essential reading for health care professionals interested in clinical endocrinology and GH.
Neurosurgery is a rapidly developing and technically demanding branch of surgery that requires a detailed knowledge of the basic neuro-sciences and a thorough clinical approach. The Oxford Textbook of Neurological Surgery is an up-to-date, objective and readable text that covers the full scope of neurosurgical practice. It is part of the Oxford Textbooks in Surgery series, edited by Professor Sir Peter Morris. The book is split into 20 overarching sections (Principles of Neurosurgery, Neuro-oncology of Intrinsic Tumours; Extra-axial Tumours and Skull Lesions; Cerebro-Pontine Angle Tumours; Sellar and Supra-Sellar Tumours; Posterior Fossa Tumours; Pineal tumours; Uncommon Tumours and Tumour Syndromes; Neurotrauma and Intensive Care; Vascular Neurosurgery; Principles of Spinal Surgery; Spinal Pathology; Spinal Trauma; Peripheral Nerve Surgery; Functional Neurosurgery; Epilepsy; Paediatric Neurosurgery; Neurosurgery for Cerebrospinal Fluid Disorders and Neurosurgical Infection). Each section takes a dual approach with, 'Generic Surgical Management' chapters that focus on specific clinical problems facing the neurosurgeon (e.g. sellar/supra-sellar tumour, Intradural Spina Tumours etc.) and 'Pathology-Specific' chapters (e.g. Glioma, Meningeal Tumours, Scoliosis and Spinal Deformity, Aneurysm etc.). Where appropriate, this division provides the reader with easily accessible information for both clinical problems which present in a regional fashion and specific pathologies. The generic chapters cover aspects such as operative approaches, neuroanatomy and nuances. Specifically each chapter in the book incorporates several strands. Firstly the fundamental neuroscience (anatomy, pathology, genetics etc.) that underlies the clinical practice. Secondly, a review of the requisite clinical investigations (e.g. angiography, electrodiagnostics, radiology). Thirdly, a thorough evidence based review of clinical practice. Following this a consideration of the key debates and controversies in the field with 'pro-' and 'con-' sections (e.g. minimally invasive spine surgery, microsurgical treatment of aneurysms) is provided. A summary of the key papers and clinical scales relevant to neurosurgery form the concluding part. The book is a 'one-stop' text for trainees and consultants in neurosurgery, residents, those preparing for sub-specialty exams and other professionals allied to surgery who need to gain an understanding of the field. It acts as both a point of reference to provide a focussed refresher for the experienced neurosurgeon as well as a trusted training resource.
Craniopharyngiomas are benign, partly cystic embryogenic malformations of the sellar region, presumably derived from Rathke cleft epithelium. With an overall incidence of 0.5–2 new cases per million population per year, approximately 30-50% of all cases represent childhood craniopharyngioma. Typical manifestations at primary diagnosis are headache, visual impairment, polyuria/polydypsia, growth retardation, and weight gain. One of the biggest challenges in treating craniopharyngioma is identifying the best candidates for the radical versus the conservative approach. It appears there is a trend towards radiotherapy in centers with past prevalent surgical approaches, and towards more radical surgical treatment strategies in centers historically conservative-oriented. There are current prospective studies underway on a national and multinational level to adopt strategies tailored to risk factors for morbidity and QOL. Therapy of choice in patients with favorable tumor localization is total resection with the intention to maintain optical nerve and hypothalamic-pituitary functions. In patients with unfavorable tumor localization (hypothalamic tumor involvement), a limited resection followed by local irradiation is recommended. The overall survival rates are high (92%). Recurrences after complete resection and progressions of residual tumor after incomplete resection are anticipated subsequent events after primary surgery. In clinical practice, the timing of postoperative residual tumor irradiation is both unclear and inconsistently regarded. Some favor immediate postoperative irradiation in the event of life-impairing clinical conditions, proactively preventing tumor progression. On the other hand, some favor a wait-and-see procedure, delaying irradiation in order to reduce both its necessity and the negative consequences associated with radiation therapy. Inarguably, immediate postoperative irradiation significantly delays tumor progression. However, progression-contingent irradiation has proved effective, as overall survival is statistically unaffected by this wait-and-see strategy. Accordingly, the appropriate time point of irradiation after incomplete resection is currently under investigation in a randomized trial (KRANIOPHARYNGEOM 2007). Quality of life is substantially reduced in appr. 50% of long-term survivors due to sequelae, notably extreme obesity due to hypothalamic involvement. Due to the lack of satisfactory long-term treatment modalities for hypothalamic sequelae, further research on molecular characteristics of craniopharyngioma, pathophysiology of hypothalamic disorders, and pharmaceutical agents to treat hypothalamic obesity are warranted. Risk-adapted surgical strategies at initial diagnosis should aim at a maximal degree of resection, respecting the integrity of optical and hypothalamic structures in order to prevent severe sequelae and therein minimizing consequences that could negative impact patient QOL. Because initial hypothalamic tumor involvement has an apriori effect on the clinical course, childhood craniopharyngioma should be recognized as a chronic disease requiring constant monitoring of the consequences and medical resources for treatment in order to provide not only optimal QOL for patients, but also to garner additional information with the intent of minimizing what at present are severe consequences of both the disease and its treatment.
Unparalleled access to the entire central nervous system with over four hundred gross neuropathology images from adult and paediatric post-mortem tissues.
This book provides evidence-based management in neuro-oncology covering all aspects such as pathology, radiology, surgery, radiation, and chemotherapy.The field of neuro-oncology is rapidly evolving and new evidence is coming out every day towards the optimal management of brain tumors. This necessitates a requirement of a complete guide that shall provide an evidence-based and personalized approach towards dealing with patients. This book also covers recent advances in personalized treatment formed through the relevant basis of anatomy, imaging, radiology, surgical, radiation and systemic treatment of brain and spinal tumors. In addition it also covers the , practical aspects of the planning of the Gamma knife and other radio surgical aspects. The book shall provide valuable assistance to practicing neuro-oncologists to practice better evidence-based personalized medicine.
The Human Hypothalamus: Neuroendocrine Disorders, Volume 181 in the Handbook of Clinical Neurology series, provides comprehensive summaries of recent research on the brain and nervous system as they relate to clinical neurology. This volume summarizes the role of the hypothalamus in neuroendocrine disorders, identifying the mechanism of action, disorder etiology, and best practices for assessment and treatment. Disorders covered include pituitary hypothalamic disorders of development and growth, hypothalamic tumor related disorders, hypothalamic autoimmune disorders and infection, disorders of vasopressin, water and sodium homeostasis, eating disorders, and gonadotropic hormone regulation disorders. - Discusses the importance of the hypothalamus in human growth and development - Reviews hypothalamic related tumors, as well as pituitary, autoimmune, vasopressin and hormone regulation disorders - Includes metabolic and eating disorders - Identifies mechanisms of disease action and etiology - Provides best practice information for assessment and treatment