Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma

Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson’s chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33–41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ2P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05–5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available

Generic ecological impact assessments of alien species in Norway: a semi-quantitative set of criteria

The ecological impact assessment scheme that has been developed to classify alien species in Norway is presented. The underlying set of criteria enables a generic and semi-quantitative impact assessment of alien species. The criteria produce a classification of alien species that is testable, transparent and easily adjustable to novel evidence or environmental change. This gives a high scientific and political legitimacy to the end product and enables an effective prioritization of management efforts, while at the same time paying attention to the precautionary principle. The criteria chosen are applicable to all species regardless of taxonomic position. This makes the assessment scheme comparable to the Red List criteria used to classify threatened species. The impact of alien species is expressed along two independent axes, one measuring invasion potential, the other ecological effects. Using this two-dimensional approach, the categorization captures the ecological impact of alien species, which is the product rather than the sum of spread and effect. Invasion potential is assessed using three criteria, including expected population lifetime and expansion rate. Ecological effects are evaluated using six criteria, including interactions with native species, changes in landscape types, and the potential to transmit genes or parasites. Effects on threatened species or landscape types receive greater weightings