Du Can, Feng Cheng-Yuan, Yuan Xian-Rui, Liu Qing, Peng Ze-Feng, Jiang Xing-Jun, Li Xue-Jun, Xiao Ge-Lei, Li Yi-Feng, Xiong Tao
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
The Institute of Skull Base Surgery and Neurooncology at Hunan, Changsha, Hunan, People's Republic of China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
World Neurosurg. 2016 Jun;90:454-468. doi: 10.1016/j.wneu.2016.03.002. Epub 2016 Mar 10.
To evaluate the outcomes of 177 cases of craniopharyngioma (CP) treated via a unilateral subfrontal approach.
A total of 177 continuous microscopic surgeries were performed by the senior author (Y.X.). The tumors were divided into 6 groups using the diaphragm sellae and the third ventricle floor as the anatomic references. The preoperative, postoperative, and long-term follow-up data were analyzed to evaluate the extent of tumor resection, recurrence, and functional status.
The subfrontal-basal approach was used in 169 (91.4%) cases. Total resection was achieved in 167 (94.4%) cases. A total of 158 patients were followed from 6 to 130 months. There were 3 perioperative and 23 delayed deaths. Twenty-two patients had tumor recurrence (12.7%). The progression-free survival was 80% at 5 years and 72% at 10 years. The overall survival was 84.0% at 2.5 years and 83.2% at 10 years. There was a significant increase of pituitary dysfunction after total resection. Neurologic function was stable in most patients. Rate of hypothalamic dysfunction and mortality were higher in patients with intraventricular CPs. Of the surviving patients, 91.8% were living independently with acceptable morbidities at the end of the study.
Most CPs extend along the intrasellar-suprasellar-third ventricle axis. A subfrontal-basal approach is a simple, safe, and effective approach to resecting CPs extending along the vertical axis. A translamina terminalis approach is an ideal corridor to resect intraventricular CP. The benefit of radical resection remains controversial, especially for CPs involving the infundibulotuberal region.
评估177例经单侧额下入路治疗的颅咽管瘤（CP）的治疗效果。
资深作者（Y.X.）共进行了177例连续的显微手术。以鞍膈和第三脑室底部为解剖参考，将肿瘤分为6组。分析术前、术后及长期随访数据，以评估肿瘤切除范围、复发情况及功能状态。
169例（91.4%）采用额下 - 基底入路。167例（94.4%）实现了全切。共158例患者接受了6至130个月的随访。围手术期死亡3例，延迟死亡23例。22例患者出现肿瘤复发（12.7%）。5年无进展生存率为80%，10年为72%。2.5年总生存率为84.0%，10年为83.2%。全切后垂体功能障碍显著增加。大多数患者神经功能稳定。脑室内颅咽管瘤患者的下丘脑功能障碍发生率和死亡率较高。在研究结束时，存活患者中有91.8%能够独立生活，且病情可接受。
大多数颅咽管瘤沿鞍内 - 鞍上 - 第三脑室轴延伸。额下 - 基底入路是切除沿垂直轴延伸的颅咽管瘤的一种简单、安全且有效的方法。经终板入路是切除脑室内颅咽管瘤的理想通道。根治性切除的益处仍存在争议，尤其是对于累及漏斗结节区域的颅咽管瘤。
