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      Correlación de evaluaciones clínicas e imagenológicos en casos con craneofaringioma: Hospital "Hermanos Ameijeiras" Translated title: Correlation between clinical evaluations with imaging classifications in cases with craniopharyngioma: "Hermanos Ameijeiras" Hospital

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          Abstract

          Resumen Objetivo. Determinar la correlación entre las evaluaciones clínicas de los estatus pituitario e hipotalámico con las clasificaciones imagenológicas de Kassam y Puget. Material y Métodos. Se realizó un estudio con diseño descriptivo, correlacional y retrospectivo, con una muestra por conveniencia de una población (N=1567) diagnosticada con tumores intracraneales en el Hospital "Hermanos Ameijeiras" de enero de 2014 a diciembre de 2018. Se incluyeron las variables: edad, sexo, manifestaciones clínicas, localización tumoral, estatus hipotalámico, estatus pituitario, características imagenológicas, compromiso hipotalámico y relación con el tallo pituitario. Los resultados se compararon y sistematizaron mediante métodos teórico y estadístico; se empleó el paquete InfoStat/L para Windows. Resultados principales. Se incluyeron 44 casos con una edad media de 32±15,8 años, predominantemente féminas (61,4%). Las manifestaciones clínicas más comunes fueron cefalea (88,6%) y trastornos visuales (77,2%), con lesiones mayores a 2 cm de diámetro con ubicación supraselar (75,1%), estatus hipotalámico Grado II (45,5%) y estatus pituitario Grado IV (38,6%) todos con realce a la administración del contraste. La asociación más significativa se demostró entre el estatus pituitario e hipotalámico (r=0,61; p=<0,0001) y con la clasificación de Puget (r=0,31; p=0,0382). Conclusiones. Los craneofaringiomas predominaron en mujeres en su segunda década de vida, con síntomas cefalálgicos y trastornos visuales. Se localizaron generalmente en la región supraselar, con presencia de quistes, áreas de calcificación y realce tras la administración de contraste por técnicas imagenológicas de Tomografía Axial y Resonancia Magnética. La correlación más significativa se demostró entre el estatus pituitario con la clasificación de Puget y el hipotalámico.

          Translated abstract

          Abstract Objectives. To determine the correlation between the clinical evaluations of the pituitary and hypothalamic status with the imaging classifications of Kassam and Puget. Material and methods. A study was carried out with a descriptive, correlational and retrospective design; with a convenience sample of a population (N = 1567) diagnosed with intracranial tumors by the Neurosurgery Service of the "Hermanos Ameijeiras" Hospital from January 2014 to December 2018. The variables age, sex, clinical manifestations, tumor location were included, hypothalamic status, pituitary status, imaging characteristics, hypothalamic involvement and relationship with the pituitary stem. Principal results. The results were collected by a questionnaire; then it was compared by theoretical and statistical methods, systematizing the information using the InfoStat / L package for Windows. Forty-four cases were included, with a mean age of 32 ± 15.8 years, predominantly females (61.4%). The most common clinical manifestations were headache (88.6%) and visual disorders (77.2%), with lesions larger than 2 cm in diameter with suprasellar location (75.1%), hypothalamic status Grade II (45.5%) and Grade IV pituitary status (38.6%) all with enhanced contrast administration. The most significant association was demonstrated between pituitary and hypothalamic status (r = 0.61, p = <0.0001) and Puget classification (r = 0.31, p = 0.0382). Conclusions. The craniopharyngioma predominated in women in his second decade of life, with symptoms headache and visual disorders. The most common location at the region supraselar with presence of cysts, calcification and luster after the administration of contrast for techniques Computerized Axial Tomography and Nuclear Magnetic Resonance. The most significant correlation was demonstrated between the pituitary status with Puget's and the hipotalámico's classification.

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          Craniopharyngioma

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            Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum.

            Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme. The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy. The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach. The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.
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              Mortality and morbidity in adult craniopharyngioma.

              A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5-2.0 cases/million/year and approximately 60 % of CP are seen in adulthood. Craniopharyngiomas have the highest mortality of all pituitary tumors. Typical initial manifestations at diagnosis in adults are visual disturbances, hypopituitarism and symptoms of elevated intracranial pressure. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health, and reduction in quality of life and cognitive function. Therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. The standardised overall mortality rate varies 2.88-9.28 in cohort studies. Patients with CP have a 3-19 fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk.
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                Author and article information

                Journal
                jonnpr
                Journal of Negative and No Positive Results
                JONNPR
                Research and Science S.L. (Madrid, Madrid, Spain )
                2529-850X
                2020
                : 5
                : 8
                : 806-818
                Affiliations
                [2] Las Tunas orgnameCentro Provincial de Medicina del Deporte Cuba raydelperezc@ 123456nauta.cu
                [1] La Habana orgnameHospital Hermanos Ameijeiras Cuba ivirgen@ 123456nauta.cu
                [3] La Habana orgnameHospital Hermanos Ameijeiras Cuba mohdez@ 123456infomed.sld.cu
                [4] La Habana orgnameHospital Hermanos Ameijeiras Cuba maguilar@ 123456infomed.sld.cu
                [6] La Habana orgnameHospital Hermanos Ameijeiras Cuba glezrojas@ 123456infomed.sld.cu
                [5] La Habana orgnameHospital Salvador Allende Cuba naibelqr@ 123456nauta.cu
                Article
                S2529-850X2020000800004 S2529-850X(20)00500800004
                10.19230/jonnpr.3418
                a251cd22-fcb5-4f56-a180-6549dbb2b76b

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 29 December 2019
                : 21 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 13
                Product

                SciELO Spain

                Categories
                Original

                resonancia magnética nuclear,tomografía axial computarizada,craneofaringioma,nuclear magnetic resonance,computerized axial tomography,craniopharyngioma

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