Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan; and Department of Neurosurgery, Pituitary Surgery Unit, University Hospital Eppendorf, Hamburg, Germany.
Neurosurg Focus. 1997 Dec 15;3(6):e4. doi: 10.3171/foc.1997.3.6.7.
Results of primary transnasal surgery were evaluated in 35 patients (18 males and 17 females) with intrasellar and suprasellar craniopharyngiomas treated between 1985 and 1996 when more refined surgical and diagnostic techniques were available. Patients ranged in age from 8 to 72 years (mean 27 years); 14 patients were younger than 18 years of age. The transnasal approach was chosen because of sellar enlargement and presence of infradiaphragmatic tumor. The paramedian portion of the normal pituitary gland was incised vertically to reach a dorsally located tumor in 25 patients. Complete tumor resection was achieved in 15 patients and subtotal removal in 19; in one patient, only aspiration of cyst contents was performed. Tumor regrowth was seen in three patients after subtotal removal; in two, total tumor removal was achieved by a second transnasal surgery, whereas radiotherapy was administered in the other. In a single patient, total tumor removal was achieved by a second transcranial surgery after cyst aspiration. The duration of the clinical follow-up period was at least 1 year. Persistent diabetes insipidus appeared after total tumor resection in five patients. Cerebrospinal fluid leakage occurred in three patients, with two requiring revision. Among 29 patients with preoperatively normal pituitary functions, 20 (69%) were preserved after primary total resection, whereas six (19.4%) of 31 previously disturbed functions were normalized. After subtotal removal including cyst aspiration, 39 (88.6%) of 44 normal functions were preserved, whereas nine (24.3%) of 37 disturbed functions were normalized. The transnasal approach should be the first choice in infradiaphragmatic craniopharyngiomas with sellar enlargement in cases in which the extrasellar portion is mostly cystic and is accessible. The concept of subtotal removal with preservation of pituitary functions, especially when treating craniopharyngioma in children, seems to be justified.
结果的主要经鼻手术评估了 35 例患者（18 男性和 17 女性）与鞍内和鞍上颅咽管瘤治疗之间 1985 年和 1996 年，当更精细的手术和诊断技术都可用。患者年龄 8 至 72 岁（平均 27 岁）；14 例患者年龄小于 18 岁。经鼻入路选择是因为蝶鞍扩大和存在膈肌下肿瘤。正常垂体腺的正中部分被垂直切开，以达到位于背部的肿瘤 25 例患者。在 15 例患者中实现了肿瘤完全切除，在 19 例患者中实现了次全切除；在 1 例患者中，仅进行了囊肿内容物的抽吸。在 3 例次全切除后肿瘤复发；在 2 例中，通过第二次经鼻手术实现了全肿瘤切除，而在另 1 例中则进行了放射治疗。在单个患者中，在囊肿抽吸后通过第二次经颅手术实现了全肿瘤切除。临床随访期至少为 1 年。在 5 例患者中，在全肿瘤切除后出现持续性尿崩症。在 3 例患者中发生脑脊液漏，其中 2 例需要修复。在 29 例术前垂体功能正常的患者中，20 例（69%）在原发性全切除后得到保留，而 31 例先前功能紊乱的患者中有 6 例（19.4%）得到正常化。在包括囊肿抽吸的次全切除后，44 例正常功能中有 39 例（88.6%）得到保留，而 37 例功能紊乱中有 9 例（24.3%）得到正常化。在蝶鞍扩大且 extrasellar 部分主要为囊肿且可接近的情况下，经鼻入路应该是膈肌下颅咽管瘤的首选方法。保留垂体功能的次全切除的概念，特别是在治疗儿童颅咽管瘤时，似乎是合理的。
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