Department of Neurosurgery, University Hospital Heidelberg, Germany.
J Neurosurg. 2012 Sep;117(3):490-7. doi: 10.3171/2012.6.JNS111885. Epub 2012 Jul 13.
Ectopic recurrence of craniopharyngioma is a rare phenomenon after transcranial resection of the primary tumor. The authors present a case of ectopic recurrent adamantinomatous craniopharyngioma of the frontal bone resected 16 years after initial transcranial resection of the primary tumor. The lesion was first radiographically described 12 years after surgery and was adjacent to the osteosynthesis plate that had been implanted at the craniotomy site. The recurrent craniopharyngioma was totally resected via a lateral eyebrow approach. No infiltration of the meninges or the brain was detected. Only 50 cases of ectopic recurrent craniopharyngioma have been described to date, with the present case being the first one with recurrence located at the skull bone. So far 2 mechanisms have been described: contamination with tumor cells alongside the surgical tract and spreading via CSF and the subarachnoid space. The authors reviewed the literature, provided the largest collection of cases so far, and performed basic statistical analysis regarding ectopic recurrence. Pediatric and adult patients as well as male and female ones are affected equally by this phenomenon. The mean time of ectopic recurrence after initial surgery was 7.1 years. Ectopic recurrence, although rare, should always be considered in a patient with a newly diagnosed intracranial lesion who has undergone transcranial craniopharyngioma resection before.
颅咽管瘤颅外复发是原发肿瘤经颅切除后罕见的现象。作者报告了 16 年前经颅切除原发肿瘤后，额骨部位出现异位复发性造釉细胞瘤颅咽管瘤的病例。该病变在术后 12 年首次进行影像学描述，且紧邻在开颅部位植入的骨板。通过眉侧入路完全切除了复发性颅咽管瘤。未发现脑膜或脑组织浸润。迄今为止，仅描述了 50 例异位复发性颅咽管瘤，本病例是首例位于颅骨的复发病例。目前已经描述了 2 种机制：手术部位的肿瘤细胞污染和通过 CSF 和蛛网膜下腔扩散。作者回顾了文献，提供了迄今为止最大的病例集，并对异位复发进行了基本的统计分析。儿童和成年患者以及男性和女性患者均同样受到这种现象的影响。初次手术后异位复发的平均时间为 7.1 年。对于曾经接受过颅咽管瘤经颅切除术的患者，如果新诊断出颅内病变，应始终考虑异位复发的可能性。
