Bidur K C, Prasad Devkota Upendra
Department of Neurosurgery, National Institute of Neurological and Allied sciences, Bansbari, Kathmandu, Nepal.
Asian J Neurosurg. 2017 Jul-Sep;12(3):514-518. doi: 10.4103/1793-5482.150228.
Debate continues as to the optimum treatment for craniopharyngioma; radical surgical resection or partial resection followed by radiotherapy. Radical surgical resection may be complicated by intraoperative injury to surrounding structures and stormy postoperative hormonal problem. This study aims to examine the result of safe maximal surgical resection.
Retrospective study of all histopathologically proven craniopharyngiomas who had undergone surgical resection over an almost 8 year period was included. Data were collected reviewing demography, clinical presentation, hormonal dysfunction, extent of resection and visual deterioration. Outcome was measured in terms of Glasgow outcome scale and recurrence.
Of 25 patients, 68% were male, and 32% were female. Age of patients ranged from 7 to 58 years with a mean of 30.12 ± 16.42 years. Patients presented with visual deterioration were 76% and with a headache were 68%. Mean duration of symptoms was 10.64 ± 14.28 months. Gross total resection was done in 21 (84%), while subtotal resection in 4 (16%) who also received subsequent adjuvant radiotherapy. During the postoperative period, diabetes insipidus developed in 84% patients, but none had it permanently. Favorable outcome was found in 88% patients. However, there were 4% operative mortality with overall mortality of 8% and tumor recurrence in 8% patients.
Gross total excision if judiciously decided intraoperatively has a favorable outcome with acceptable morbidity.
关于颅咽管瘤的最佳治疗方法仍存在争议；是进行根治性手术切除还是部分切除后进行放疗。根治性手术切除可能会因术中对周围结构的损伤以及术后棘手的激素问题而复杂化。本研究旨在探讨安全最大程度手术切除的结果。
纳入了对近8年期间所有经组织病理学证实接受过手术切除的颅咽管瘤患者的回顾性研究。通过回顾人口统计学、临床表现、激素功能障碍、切除范围和视力恶化情况来收集数据。根据格拉斯哥预后量表和复发情况来衡量结果。
25例患者中，68%为男性，32%为女性。患者年龄范围为7至58岁，平均年龄为30.12±16.42岁。出现视力恶化的患者占76%，出现头痛的患者占68%。症状的平均持续时间为10.64±14.28个月。21例（84%）患者进行了全切除，4例（16%）患者进行了次全切除，这4例患者随后还接受了辅助放疗。术后期间，84%的患者出现了尿崩症，但无一例永久性出现。88%的患者预后良好。然而，手术死亡率为4%，总死亡率为8%，8%的患者出现肿瘤复发。
如果术中明智地决定进行全切除，则预后良好，发病率可接受。
