Kim Sung Kwon, Kim Yong Hwy, Park Chul-Kee, Kim Dong Gyu, Jung Hee-Won
Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Acta Neurochir (Wien). 2014 Oct;156(10):1917-22. doi: 10.1007/s00701-014-2150-5. Epub 2014 Jun 20.
The aim of this study was to evaluate the effectiveness of the extended endoscopic endonasal transsphenoidal approach (TSA) for recurrent or residual craniopharyngiomas, focusing on the extent of tumor resection and complications resulting from surgery at a single institution.
Twelve adult patients (six men and six women) underwent extended endoscopic endonasal TSA for a recurrent or residual craniopharyngioma after a previous surgical intervention at a single institution by a single surgeon. The mean number of surgeries patients had undergone before TSA was 1.3 (range, 1-3). The mean period between patients' most recent surgery and extended TSA was 55.9 months (range, 1-184). The mean preoperative (that is, pre-extended TSA) tumor volume was 2.87 cm³. The mean follow-up period was 15.8 months (range, 4-32). We reviewed clinical and radiological features in each case, focusing on the degree of tumor resection as well as endocrinological and ophthalmological outcomes.
Gross total resection was achieved in ten patients (83.3 %), and the mean resection rate was 87 % in the other two cases. There were no significant differences between pre- and postoperative endocrine function, except in one patient who suffered postoperative panhypopituitarism resulting in pituitary stalk resection, which was necessary because of obvious tumor involvement. Three patients suffered transient diabetic insipidus (DI). With respect to ophthalmological outcomes, three patients showed improvement, two others showed decline, and the remainder showed no significant changes.
The extended endoscopic endonasal transsphenoidal approach is an effective and safe surgical approach for treating recurrent or residual craniopharyngioma.
本研究旨在评估扩大经鼻内镜经蝶窦入路（TSA）治疗复发性或残留颅咽管瘤的有效性，重点关注肿瘤切除范围及单一机构手术所致并发症。
12例成年患者（6例男性，6例女性）在单一机构由同一位外科医生对复发性或残留颅咽管瘤行扩大经鼻内镜经蝶窦入路手术。患者在接受经蝶窦入路手术前平均接受的手术次数为1.3次（范围1 - 3次）。患者最近一次手术与扩大经蝶窦入路手术之间的平均间隔时间为55.9个月（范围1 - 184个月）。术前（即扩大经蝶窦入路手术前）肿瘤平均体积为2.87 cm³。平均随访期为15.8个月（范围4 - 32个月）。我们回顾了每例患者的临床和影像学特征，重点关注肿瘤切除程度以及内分泌和眼科方面的结果。
10例患者（83.3%）实现了肿瘤全切除，另外2例的平均切除率为87%。术前和术后内分泌功能无显著差异，但有1例患者术后出现全垂体功能减退，因肿瘤明显侵犯导致垂体柄切除。3例患者出现短暂性尿崩症（DI）。在眼科方面，3例患者病情改善，2例患者病情恶化，其余患者无显著变化。
扩大经鼻内镜经蝶窦入路是治疗复发性或残留颅咽管瘤的一种有效且安全的手术方法。
