Jang Woo Young, Lee Kwan-Sung, Son Byung Chul, Jeun Sin-Soo, Hong Yong-Kil, Lee Sang Won, Yang Seung-Ho
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Pediatr Neurosurg. 2009;45(6):451-5. doi: 10.1159/000277620. Epub 2010 Jan 26.
Controversy continues over the optimal management of recurrent craniopharyngiomas. Our strategy for approaching repeatedly recurrent craniopharyngiomas in pediatric patients has been to decompress vital structures and relieve the symptoms as early as possible. The purpose of this study was to present our experiences of repeatedly recurrent craniopharyngiomas and the pattern of failure associated with treatment.
A retrospective review was conducted on 7 pediatric patients who underwent resection >2 times in a single institution between 1990 and 2004. Resections were performed 3-8 times for each patient. Variables including tumor size, consistency and location, extent of resection, adjuvant therapy and morbidity were evaluated.
Thirty-two operations were performed in 7 pediatric patients. Total resection was not achieved by the third surgery and thereafter, and the interval between each surgery became shorter. Appetite disorders, neurocognitive disorders and behavioral disorders occurred following repeat surgeries.
Repeat operations are associated with a high failure rate of tumor control, even though they can help relieve neurologic symptoms. It is suggested that the number of repeat operations should be limited.
复发性颅咽管瘤的最佳治疗方案仍存在争议。我们针对小儿复发性颅咽管瘤的治疗策略是尽早减压重要结构并缓解症状。本研究的目的是介绍我们治疗多次复发性颅咽管瘤的经验以及与治疗相关的失败模式。
对1990年至2004年间在单一机构接受过2次以上切除术的7例儿科患者进行回顾性研究。每位患者接受了3至8次手术。评估了包括肿瘤大小、质地和位置、切除范围、辅助治疗和发病率等变量。
7例儿科患者共进行了32次手术。第三次及之后的手术均未实现全切，且每次手术间隔时间变短。重复手术后出现了食欲障碍、神经认知障碍和行为障碍。
重复手术虽然有助于缓解神经症状，但与肿瘤控制的高失败率相关。建议限制重复手术的次数。
