Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo 162-8666, Japan.
Neurosurg Rev. 2010 Jan;33(1):71-81. doi: 10.1007/s10143-009-0220-6.
Although many authors have described treatment strategies for craniopharyngiomas, the optimal treatment of craniopharyngiomas remains controversial. This study aimed to define an adequate surgical strategy for craniopharyngiomas by reviewing the long-term functional performance of patients treated by current and past treatment modalities. Fifty-five patients with longer than 5 years of follow-up were selected for the present long-term study. The duration of follow-up ranged from 5.5 to 33 years (median, 14.8 years). There were 28 adult patients (14 males; median age, 44.4 years) and 27 children younger than 16 years of age (15 males; median age, 8.1 years). The patients were divided into the following treatment groups: single surgery (group A; n=14 multiple surgeries (group B; n=8), surgery or surgeries followed by radiotherapy (group C; n=23), surgery or surgeries (partial removal) followed by radiotherapy + additional treatments (multiple surgeries and/or re-irradiation; group D; n=10). In addition to the routine assessments of neurological, endocrine, and visual outcomes, the level of daily functioning was analyzed using the Karnofsky Performance Scale (KPS). Statistical analysis of relationship between KPS score and treatment mode demonstrated that group D had a significantly lower KPS score (F=5.82, p=0.0017). Furthermore, mortality, cognitive function, and visual function were significantly better in groups A, B, and C than in group D. Multiple regression analysis demonstrated that cognitive dysfunction, visual disturbance, and treatment mode were independent covariates that significantly affected postoperative KPS score. Adequate primary treatment for craniopharyngiomas is important to avoid subsequent multiple treatments. Craniopharyngiomas should be removed surgically as far as possible but without further deteriorating cognitive and visual functions, either as total resection or subtotal resection with a small remnant that is controllable by radiation therapy.
虽然许多作者已经描述了颅咽管瘤的治疗策略，但颅咽管瘤的最佳治疗方法仍存在争议。本研究旨在通过回顾当前和过去治疗方式治疗的患者的长期功能表现，来确定颅咽管瘤的适当手术策略。本长期研究选择了 55 例随访时间超过 5 年的患者。随访时间从 5.5 年到 33 年不等（中位数为 14.8 年）。其中 28 例为成人患者（14 例男性；中位数年龄为 44.4 岁），27 例为 16 岁以下儿童（15 例男性；中位数年龄为 8.1 岁）。患者分为以下治疗组：单次手术（A 组，n=14；多次手术，B 组，n=8），手术或手术加放疗（C 组，n=23），手术或手术（部分切除）加放疗+附加治疗（多次手术和/或再放疗，D 组，n=10）。除了常规评估神经、内分泌和视觉结果外，还使用 Karnofsky 表现量表（KPS）分析日常生活功能水平。KPS 评分与治疗方式的关系的统计学分析表明，D 组的 KPS 评分明显较低（F=5.82，p=0.0017）。此外，A、B 和 C 组的死亡率、认知功能和视觉功能均明显优于 D 组。多元回归分析表明，认知功能障碍、视觉障碍和治疗方式是显著影响术后 KPS 评分的独立协变量。颅咽管瘤的充分初始治疗对于避免后续多次治疗非常重要。颅咽管瘤应尽可能通过手术切除，但不能进一步恶化认知和视觉功能，可采用全切除或次全切除，残留少量肿瘤可通过放疗控制。
