Zygourakis Corinna C, Kaur Gurvinder, Kunwar Sandeep, McDermott Michael W, Madden Michelle, Oh Taemin, Parsa Andrew T
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA.
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA; Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Clin Neurosci. 2014 Sep;21(9):1558-66. doi: 10.1016/j.jocn.2014.03.005. Epub 2014 Jun 6.
There is debate regarding the appropriate treatment for craniopharyngiomas, which often present symptomatically given their proximity to critical brain structures, and pose significant surgical challenges. The goal of this study is to identify which patient and tumor characteristics are associated with specific preoperative symptoms, surgical complications, patient outcomes, and tumor recurrence in order to guide craniopharyngioma treatment. We retrospectively identified 84 patients with newly diagnosed craniopharyngiomas treated at our institution from 1986-2010. We used binary logistic regression and survival analysis to determine the effect of several variables (including sex, age, tumor size, location, surgical approach, and extent of resection) on preoperative symptoms and postoperative outcomes, including complication rates and tumor recurrence. Age and tumor location were associated with increased rates of preoperative symptoms, with children being more likely than adults to present with endocrine dysfunction, and intraventricular tumors being more likely than extraventricular tumors to present with headaches and hydrocephalus. A transcranial surgical approach was associated with 1.5 times higher rate of surgical complications than transsphenoidal surgery, while only intraventricular tumor location was associated with a poorer patient outcome. The main factor significantly associated with tumor recurrence was extent of resection. We conclude that intraventricular tumor location is most highly correlated with preoperative symptoms. If feasible, transsphenoidal approaches are preferred, as they result in fewer surgical complications, and gross total resections are optimal because they lead to lower rates of recurrence. When gross total resection is not possible, we favor multimodal treatment approaches.
关于颅咽管瘤的恰当治疗存在争议，由于其靠近关键脑结构，常出现症状，且带来重大手术挑战。本研究的目的是确定哪些患者和肿瘤特征与特定的术前症状、手术并发症、患者预后及肿瘤复发相关，以指导颅咽管瘤的治疗。我们回顾性地确定了1986年至2010年在本机构接受治疗的84例新诊断颅咽管瘤患者。我们使用二元逻辑回归和生存分析来确定几个变量（包括性别、年龄、肿瘤大小、位置、手术入路和切除范围）对术前症状和术后结果（包括并发症发生率和肿瘤复发）的影响。年龄和肿瘤位置与术前症状发生率增加相关，儿童比成人更易出现内分泌功能障碍，脑室内肿瘤比脑室外肿瘤更易出现头痛和脑积水。经颅手术入路的手术并发症发生率比经蝶窦手术高1.5倍，而只有脑室内肿瘤位置与较差的患者预后相关。与肿瘤复发显著相关的主要因素是切除范围。我们得出结论，脑室内肿瘤位置与术前症状相关性最高。如果可行，首选经蝶窦入路，因为其手术并发症较少，而全切是最佳选择，因为可降低复发率。当无法进行全切时，我们倾向于多模式治疗方法。
