Classifying CPs within the overly vague, uninformative category “suprasellar” prevents gaining any true insight regarding the risks associated with the surgical procedure employed. Routine MRI obtained with conventional T1- and T2-weighted sequences along the midsagittal and coronal trans-infundibular planes allow an accurate and reliable preoperative definition of CP topography. CPs developing primarily within the infundibulum and/or tuberal region of the hypothalamus, as well as those wholly located within the 3V, should be distinguished preoperatively from those lesions originally expanding beneath the 3V floor (3VF), the true suprasellar tumors. Among adult patients, about 40% of CPs correspond to infundibulo-tuberal tumors expanding primarily within the 3VF, above an intact pituitary gland and stalk. This subgroup of CPs shows strong adherences to the surrounding hypothalamus, as they are embedded within a wide band of reactive gliotic tissue, usually infiltrated by microscopic finger-like solid cords of tumor tissue. In elderly patients, a significant proportion of CPs correspond to papillary tumors developing above an intact 3VF, usually showing small pedicle-like or sessile-like attachments to the infundibulum. With the current diagnostic MRI workup routinely employed for CPs, it is possible, for the majority of lesions, to preoperatively differentiate these topographical variants and predict the type of CP-hypothalamus relationship that will be found during surgery.


中文翻译：

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致编辑的信：老年人颅咽管瘤：肿瘤地形对手术风险评估的关键影响

将 CP 归入过于模糊、信息量不足的“鞍上”类别，无法真正了解与所采用的外科手术相关的风险。使用常规 T1 和 T2 加权序列沿中矢状和冠状跨漏斗平面获得的常规 MRI 允许准确和可靠的术前定义 CP 地形。主要在下丘脑漏斗部和/或结节区域发展的CP，以及完全位于3V内的CP，应在术前与那些最初在3V底（3VF）下方扩展的病变（真正的鞍上肿瘤）区分开来。在成年患者中，约 40% 的 CP 对应于漏斗结节肿瘤，主要在 3VF 内扩张，位于完整的垂体和茎上方。该 CP 亚组与周围的下丘脑具有很强的粘附性，因为它们嵌入广泛的反应性胶质组织中，通常被肿瘤组织的微观指状实心索浸润。在老年患者中，相当大比例的 CP 对应于在完整 3VF 以上发展的乳头状肿瘤，通常显示漏斗部的小蒂状或无蒂状附件。通过目前常规用于 CP 的诊断性 MRI 检查，对于大多数病变，可以在术前区分这些地形变异并预测手术期间将发现的 CP-下丘脑关系的类型。通常被肿瘤组织的微观指状实心索浸润。在老年患者中，相当大比例的 CP 对应于在完整 3VF 以上发展的乳头状肿瘤，通常显示漏斗部的小蒂状或无蒂状附件。通过目前常规用于 CP 的诊断性 MRI 检查，对于大多数病变，可以在术前区分这些地形变异并预测手术期间将发现的 CP-下丘脑关系的类型。通常被肿瘤组织的微观指状实心索浸润。在老年患者中，相当大比例的 CP 对应于在完整 3VF 以上发展的乳头状肿瘤，通常显示漏斗部的小蒂状或无蒂状附件。通过目前常规用于 CP 的诊断性 MRI 检查，对于大多数病变，可以在术前区分这些地形变异并预测手术期间将发现的 CP-下丘脑关系的类型。