Yadav Yad Ram, Nishtha Yadav, Vijay Parihar, Shailendra Ratre, Yatin Kher
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Department of Radiodiagnosis and Imaging All India Institute of Medical Science, New Delhi, India.
Asian J Neurosurg. 2015 Jan-Mar;10(1):10-6. doi: 10.4103/1793-5482.151502.
Craniopharyngiomas treatment has been challenging because of their anatomical location. The endoscopic endonasal (EE) trans-sphenoidal approach is indicated in sellar, supra sellar, selected intraventricular lesions in adults and children. We are reporting our initial experience of 44 patients managed by EE approach.
This is a retrospective study of 44 craniopharyngiomas. The goal of surgery was gross-total resection in all cases. All patients underwent pre- and post-operative comprehensive ophthalmological and endocrinological evaluation. Lumbar drain at the start of the operation was used in all cases with tumor larger than 3 cm maximum diameter. Binostril technique vascularized nasoseptal flap and multilayer closure of the dural defect were used. Wide sphenoidotomy, posterior ethmoidectomy, tuberculum selle, and planum removal were performed in all cases. Perioperative antibiotic prophylaxis was used for 72 h.
There were 44 patients of age ranging from 8 to 65 (mean: 42) years. Diameter of the tumor varied from 3.1 cm to 6.6 cm (average: 4.3 cm). Visual and pituitary dysfunctions were observed in 44 and 33, respectively, before surgery. Vision improvement, gross-total removal, cerebrospinal fluid (CSF) leak and recurrence were observed in 34, 26, four and six patients, respectively. Average follow-up was 19 months.
Endoscopic endonasal trans-sphenoidal approach for craniopharyngioma is safe and effective alternative to transcranial approach in selected patients. Although this technique is associated with effective tumor removal and improved visual outcome, CSF leak, and endocrine dysfunctions remain a major challenge.
颅咽管瘤因其解剖位置，治疗一直具有挑战性。鼻内镜经蝶窦入路适用于成人和儿童的鞍区、鞍上区以及部分脑室内病变。我们报告了采用鼻内镜入路治疗44例患者的初步经验。
这是一项对44例颅咽管瘤的回顾性研究。所有病例的手术目标均为全切除。所有患者均接受了术前和术后全面的眼科和内分泌学评估。对于所有最大直径大于3 cm的肿瘤病例，手术开始时均使用了腰大池引流。采用双侧鼻孔技术、带血管蒂鼻中隔瓣和硬脑膜缺损的多层缝合。所有病例均进行了广泛的蝶窦切开术、后筛窦切除术、鞍结节和蝶骨平台切除术。围手术期预防性使用抗生素72小时。
44例患者年龄在8至65岁（平均42岁）之间。肿瘤直径在3.1 cm至6.6 cm之间（平均4.3 cm）。术前分别有44例和33例出现视力和垂体功能障碍。术后分别有34例视力改善、26例实现全切除、4例出现脑脊液漏和6例复发。平均随访时间为19个月。
对于部分患者，鼻内镜经蝶窦入路治疗颅咽管瘤是一种安全有效的替代开颅手术的方法。尽管该技术能有效切除肿瘤并改善视力，但脑脊液漏和内分泌功能障碍仍然是主要挑战。
