Shi X, Wang Z
Department of Neurosurgery, Affiliated Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Zhonghua Wai Ke Za Zhi. 2001 Aug;39(8):608-10.
To study the effective method for surgical treatment of craniopharyngioma.
110 patients with craniopharyngioma were operated on. Their tumors were totally removed. Of the 110 patients, 62 were male and 58 female, with age ranging from 15 to 67 years (mean 34.4 years). Pterional approach was performed in 102 patients, subfrontal approaches in 5, and transcallosum into the anterior third ventricle part in 3. The perforating arteries from the carotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures were preserved when the tumors were excised by pterional approaches via the parachiasmal opticocarotid, carotidotentorial spaces and by opening the lamina terminals. The neural structures of the third ventricular floor were preserved by the transcallosum approach to the anterior part of the third ventricular floor. The cystic fluid was initially aspirated from cystic tumors, solid portion of the tumor was excised by piecemeal and calcification mass was crushed for removal.
Of the 110 patients, 101 had a total removal of tumor, 7 a subtotal removal of tumor, and 3 a partial removal of tumors. The pituitary stalk was preserved in 57 patients, ruptured in 29, and unidentified in 24. In 54 patients with diabetes insipidus after surgery, 52 recovered from 3 months to one year after surgery and only two patients failed to over one year after surgery. 52 patients had normal blood sodium level 3 months after surgery. Three patients after surgery had decreased visual acuity. In 3 patients with oculomotor paralysis after surgery, one failed recover till one year. Two patients after surgery had temporal paralysis of the extremities. All the patients after surgery were followed up for one month to five years (mean, 1.1 years). Four patients died after surgery.
The proper surgical approaches for the removal of craniopharyngiomas are the key to achieve good surgical results and avoid the injury to the hypothalamic structures and the perforating arteries to hypothalamus.
探讨颅咽管瘤的有效手术治疗方法。
对110例颅咽管瘤患者进行手术，肿瘤均被全切。110例患者中，男性62例，女性58例，年龄15至67岁（平均34.4岁）。采用翼点入路102例，额下入路5例，经胼胝体入第三脑室前部3例。经翼点入路经视交叉旁视神经 - 颈动脉、颈动脉 - 小脑幕间隙并打开终板切除肿瘤时，保留颈内动脉、前后交通动脉及脉络膜前动脉至下丘脑结构的穿动脉。经胼胝体入路至第三脑室底部前部时保留第三脑室底部神经结构。对囊性肿瘤先抽出囊液，肿瘤实体部分分块切除，钙化块予以磨碎取出。
110例患者中，101例肿瘤全切，7例次全切除，3例部分切除。57例患者垂体柄保留，29例破裂，24例未明确。术后54例出现尿崩症，52例在术后3个月至1年恢复，仅2例术后1年以上未恢复。52例患者术后3个月血钠水平正常。3例术后视力下降。3例术后动眼神经麻痹，1例术后1年未恢复。2例术后出现肢体颞侧瘫痪。所有患者术后随访1个月至5年（平均1.1年）。4例术后死亡。
选择合适的手术入路切除颅咽管瘤是取得良好手术效果、避免下丘脑结构及下丘脑穿动脉损伤的关键。
