Pascual José María, Prieto Ruth, Carrasco Rodrigo, Castro-Dufourny Inés, Strauss Sewan, Gil-Simoes Ricardo, Barrios Laura
Servicio de Neurocirugía, Hospital Universitario de La Princesa, Madrid, España.
Servicio de Neurocirugía, Hospital Universitario Puerta de Hierro, Madrid, España.
Neurocirugia (Astur). 2014 Jul-Aug;25(4):154-69. doi: 10.1016/j.neucir.2014.04.002. Epub 2014 Jun 5.
This study reviews the historical evolution of pathological, neuroradiological and surgical evidence that influenced the topographical concepts and classification schemes of craniopharyngiomas.
An extensive, systematic analysis of the surgical series of craniopharyngiomas reported in the literature was performed (n=145 series, 4,588 tumours) to describe the fundamental anatomical findings guiding the topographical classification schemes used for this tumour throughout history. These findings were compared with topographical relationships reported for well-described operated craniopharyngiomas (n=224 cases) as well as for non-operated cases studied in autopsies (n=201 cases).
Two major variables define the topography of a craniopharyngioma: its position relative to the sellar diaphragm and its degree of invasion of the third ventricle floor. Suprasellar lesions displacing the third ventricle floor upwards (pseudointraventricular craniopharyngiomas) are amenable to safe, radical resection and must be differentiated from lesions developing primarily within the third ventricle floor (infundibulo-tuberal or not strictly intraventricular craniopharyngiomas). The latter group typically shows tight, circumferential adhesion to the third ventricle floor and represents approximately 40% of all cases.
A triple-axis topographical model for craniopharyngiomas that includes the degree of hypothalamus invasion is useful in planning surgical approach and degree of resection. The group of infundibulo-tuberal craniopharyngiomas associates the highest risk of hypothalamic injury (50%). The endoscopically-assisted extended transsphenoidal approach provides a proper view to assess the topography of the craniopharyngioma and its degree of adherence to the hypothalamus.
本研究回顾了影响颅咽管瘤局部解剖学概念和分类方案的病理学、神经放射学及外科手术证据的历史演变。
对文献报道的颅咽管瘤手术系列进行了广泛、系统的分析（n = 145个系列，4588例肿瘤），以描述贯穿历史用于该肿瘤局部解剖分类方案的基本解剖学发现。将这些发现与已详细描述的手术颅咽管瘤（n = 224例）以及尸检研究的非手术病例（n = 201例）所报道的局部解剖关系进行比较。
两个主要变量决定了颅咽管瘤的局部解剖位置：其相对于鞍膈的位置及其对第三脑室底部的侵犯程度。向上推移第三脑室底部的鞍上病变（假性脑室内颅咽管瘤）适合进行安全的根治性切除，必须与主要在第三脑室底部发展的病变（漏斗结节型或非严格脑室内颅咽管瘤）相鉴别。后一组通常显示与第三脑室底部紧密、周向粘连，约占所有病例的40%。
包含下丘脑侵犯程度的颅咽管瘤三轴局部解剖模型有助于规划手术入路和切除程度。漏斗结节型颅咽管瘤组下丘脑损伤风险最高（50%）。内镜辅助扩大经蝶入路能提供合适视野以评估颅咽管瘤的局部解剖位置及其与下丘脑的粘连程度。
