Shi Xiang-en, Wu Bin, Zhou Zhong-qing, Fan Tao, Zhang Yong-li
Department of Neurosurgery, Brain Science Institute of Beijing, Fuxing Hopital, Capital Medical University, Beijing 100038, China.
Chin Med J (Engl). 2006 Oct 5;119(19):1653-63.
Generally, total surgical removal of craniopharyngioma results in satisfactory outcome with a low recurrence rate, however, the location of the tumor and its adherence to the hypothalamic structures can make the operation difficult. The goal of the present study was to assess the outcome of craniopharyngiomas in 284 patients treated surgically.
A total of 284 patients (151 men and 133 women) with craniopharyngioma were treated surgically by our neurosurgeons from January 1996 to March 2006. Among them, 226 (79.6%) patients were adults (15 years of age or older; mean, 35.8 +/- 10.6), 58 (20.4%) were children (14 years of age or younger; mean, 9.1 +/- 3.8). The diameter of the tumors were 2.0 - 9.0 cm (mean, 36.54 +/- 11.4). The tumors were classified into the superior (23 patients) and inferior ventricular (261) types according to the location of the tumor relative to the third ventricular floor. For the patients with craniopharyngioma of inferior ventricular type, pterional approach was used in 191 (67.3%) patients, subfrontal approach in 17 (6.0%), and translamina terminalis through frontobasal interhemispheric approach in 53 (18.7%). For those with the tumors of superior ventricular type, transcallosal approach into the anterior third ventricle was done in 10 (3.5%) patients, and the lamina terminalis approach in 13 (4.6%). Of the 284 patients, 204 (71.8%) were followed up for 0.5 to 8 years (mean, 2.1 +/- 1.8), including 162 patients received total tumor removal, and 37 underwent subtotal or partial removal.
Total, subtotal and partial removal of the tumors were achieved in 237 (83.5%), 34 (12.0%) and 13 (4.5%) patients, respectively. The pituitary stalk was preserved in 176 (62.0%) patients, severed in 52 (18.3%), and unidentified in 56 (19.7%). Twelve (4.2%) patients died within one month after the surgery. During the follow-up, 23 (14.1%) patients experienced tumor recurrence 1.0 - 3.5 years (mean, 1.8 +/- 1.6) after total tumor removal, and 24 (64.9%) had recurrent tumor 0.25 - 1.5 years (mean, 0.5 +/- 0.4) after subtotal or partial resection. Normal activities of daily living were regained in 63 (80%) patients, independence in 29 (14.2%), and daily life with assistance in 9 (4.4%). Four (2.0%) patients died 0.9 - 3 years (mean, 1.6 +/- 1.4) after discharge from hospital, 3 of them died of hypothalamic deficiency.
We can protect the hypothalamic structures and its perforating arteries by choosing surgical approaches according to the location of craniopharygioma relative to the third ventricular floor. The mortality, morbidity, and recurrence rate in patients received total resection are lower than those of patients underwent subtotal or partial resections. In addition, preservation of the pituitary stalk is critical when total tumor resection is feasible.
一般来说，颅咽管瘤的手术全切可带来满意的预后且复发率低，然而，肿瘤的位置及其与下丘脑结构的粘连会使手术变得困难。本研究的目的是评估284例接受手术治疗的颅咽管瘤患者的预后。
1996年1月至2006年3月，我们的神经外科医生对总共284例颅咽管瘤患者（151例男性和133例女性）进行了手术治疗。其中，226例（79.6%）患者为成年人（15岁及以上；平均年龄35.8±10.6岁），58例（20.4%）为儿童（14岁及以下；平均年龄9.1±3.8岁）。肿瘤直径为2.0 - 9.0 cm（平均36.54±11.4）。根据肿瘤相对于第三脑室底的位置，将肿瘤分为上型（23例）和下脑室型（261例）。对于下脑室型颅咽管瘤患者，191例（67.3%）采用翼点入路，17例（6.0%）采用额下入路，53例（18.7%）采用经终板经额底半球间入路。对于上脑室型肿瘤患者，10例（3.5%）采用经胼胝体入路进入第三脑室前部，13例（4.6%）采用终板入路。284例患者中，204例（71.8%）接受了0.5至8年的随访（平均2.1±1.8年），其中162例患者肿瘤全切，37例接受次全或部分切除。
分别有237例（83.5%）、34例（12.0%）和13例（4.5%）患者实现了肿瘤全切、次全切除和部分切除。176例（62.0%）患者的垂体柄得以保留，52例（18.3%）被切断，56例（19.7%）情况不明。12例（4.2%）患者在术后1个月内死亡。在随访期间，23例（14.1%）患者在肿瘤全切后1.0 - 3.5年（平均1.8±1.6年）出现肿瘤复发，24例（64.9%）在次全或部分切除后0.25 - 1.5年（平均0.5±0.4年）出现肿瘤复发。63例（80%）患者恢复了正常日常生活，29例（14.2%）能够独立生活，9例（4.4%）在他人协助下生活。4例（2.0%）患者在出院后0.9 - 3年（平均1.6±1.4年）死亡，其中3例死于下丘脑功能减退。
根据颅咽管瘤相对于第三脑室底的位置选择手术入路，我们能够保护下丘脑结构及其穿动脉。接受全切的患者的死亡率、发病率和复发率低于接受次全或部分切除的患者。此外，在可行肿瘤全切时，保留垂体柄至关重要。
