Department of Neurosurgery, Beijing Tiantan Hospital Beijing, Capital Medical University, Beijing, People's Republic of China.
Department of Neurosurgery, Beijing Tiantan Hospital Beijing, Capital Medical University, Beijing, People's Republic of China.
World Neurosurg. 2014 May-Jun;81(5-6):773-82. doi: 10.1016/j.wneu.2013.02.011. Epub 2013 Feb 8.
This study was designed to evaluate the clinical, radiologic, histologic, and surgical outcome characteristics of this disease treated in a single institution.
Sixteen adult patients underwent transsphenoidal microsurgery from October 2005 to December 2010 at Neurosurgical Center of Beijing Tiantan Hospital. The clinical, radiological, operative, and pathological findings of the patients were reviewed retrospectively.
Pituitary dysfunction was presented in 12 patients, visual acuity and/or field deterioration in 11 patients, and headache in 8 patients. Hyperprolactinemia was presented in 7 of 9 female patients. All lesions were resected by transsphenoidal microsurgery as the primary procedure. A gross total resection was achieved in 3 of 16 patients, a radical subtotal resection in the remaining 13 patients. Nine cases were histologically classified as adamantinous subtype. After a mean follow-up of 50 months, 2 patients experienced recurrence. All female patients who had hyperprolactinemia experienced a gain of function postoperatively. Six patients experienced new diabetes insipidus. Visual field improved or normalized in 8 of 9 patients. Visual acuity improved in 1 case, and worsened in 1 patient.
Primary adult infradiaphragmatic craniopharyngiomas are relatively rare lesions occurring in young adults. Pituitary dysfunction, visual acuity and/or field deterioration, and headache were the most common chief symptoms. Transsphenoidal surgery, including tearing the cyst walls off the diaphragma sellae and protecting normal pituitary tissue as much as possible, is recommended. Although at the risk of impairing the function of anterior pituitary, transsphenoidal surgery results in a high rate of both visual field and hyperprolactinemia improvement with a low associated risk of recurrence. In terms of pathological aspects, the adamantinous subtype was more common.
本研究旨在评估单中心治疗的这种疾病的临床、影像学、组织学和手术结果特征。
2005 年 10 月至 2010 年 12 月，北京天坛医院神经外科中心对 16 例成年患者进行了经蝶窦显微手术。回顾性分析患者的临床、影像学、手术和病理发现。
12 例患者出现垂体功能障碍，11 例患者视力和/或视野恶化，8 例患者头痛。7 例女性患者出现高催乳素血症。所有病变均经蝶窦显微手术作为主要手术切除。16 例患者中，3 例实现大体全切除，13 例实现根治性次全切除。9 例组织学分类为造釉细胞瘤型。平均随访 50 个月后，2 例患者复发。所有高催乳素血症的女性患者术后均出现功能亢进。6 例患者出现新的尿崩症。9 例患者中，8 例视野改善或正常化。1 例视力改善，1 例视力恶化。
成人鞍下颅咽管瘤相对少见，发生于年轻成人。垂体功能障碍、视力和/或视野恶化以及头痛是最常见的主要症状。推荐经蝶窦手术，包括撕除鞍膈上的囊肿壁并尽可能保护正常垂体组织。尽管有损害前垂体功能的风险，但经蝶窦手术可使视野和高催乳素血症的改善率高，复发风险低。在病理方面，造釉细胞瘤型更为常见。
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