Tang Bin, Xiao Limin, Xie Shenhao, Huang Guanlin, Wang Zhigang, Zhou Dongwei, Zeng Erming, Hong Tao
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Clin Neurol Neurosurg. 2018 May;168:38-45. doi: 10.1016/j.clineuro.2018.02.002. Epub 2018 Feb 6.
Removal of recurrent or residual symptomatic craniopharyngiomas is more challenging than the primary surgery. The extended endoscopic endonasal (EEE) approach has been proposed an alternative surgical route for removal of various suprasellar tumors including craniopharyngiomas currently. In this study, we summarized the operative experience and described the feasibility and advantages of this technique in recurrent or residual symptomatic craniopharyngiomas.
A retrospective review of 15 patients (9 males and 6 females) whom underwent EEE approach between April 2012 and February 2017, were included in this study. The lesions included 8 purely suprasellar craniopharyngiomas (2 extraventricular, 6 intraextraventricular), 3 both intra- and suprasellar craniopharyngiomas, and 4 intrasellar craniopharyngiomas. The mean preoperative (that is, EEE approach) tumor volume was 10.54 cm. The mean follow-up period was 23.1 months (range, 8-54). All patients were analyzed in terms of the treatment effect, complictions and follow-up results.
Total removal of tumors was achieved in 12 patients (80.0%) and subtotal removal in 3 cases (20.0%). The pituitary stalks were identified in 11 patients during operations and secured in 8 patients. Postoperative visual acuity was improved in 10 cases, and normalization of the impairment was achieved in 3 patients. There were no significant differences between pre and postoperative endocrine function, except in one patient with normal preoperative pituitary hormone function who suffered postoperative hypopituitarism. Postoperative diabetes insipidus (DI) occurred in 14 patients including 6 patients who had long-term DI and others reporting transient postoperative DI. No cerebrospinal fluid (CSF) leak was identified. There were no deaths or major complications. Obesity developed in 2 patients, with no deaths and recurrent cases during follow-up period.
The pure EEE approach is a safe, effective alternative for treatment of recurrent or residual symptomatic craniopharyngiomas owing to its advantages including wide-angle view, close observation and elimination of brain retraction. Larger studies with further follow-up is needed to assess the long-term efficacy of this minimal access approach.
切除复发性或残留的有症状颅咽管瘤比初次手术更具挑战性。目前，扩大经鼻内镜（EEE）入路已被提议作为切除包括颅咽管瘤在内的各种鞍上肿瘤的一种替代手术途径。在本研究中，我们总结了手术经验，并描述了该技术在复发性或残留的有症状颅咽管瘤中的可行性和优势。
本研究纳入了2012年4月至2017年2月期间接受EEE入路手术的15例患者（9例男性，6例女性）。病变包括8例单纯鞍上颅咽管瘤（2例脑室外型，6例脑室内外型），3例鞍内和鞍上颅咽管瘤，以及4例鞍内颅咽管瘤。术前（即EEE入路时）肿瘤平均体积为10.54立方厘米。平均随访期为23.1个月（范围8 - 54个月）。对所有患者的治疗效果、并发症及随访结果进行分析。
12例患者（80.0%）实现了肿瘤全切，3例（20.0%）次全切。手术中11例患者识别出垂体柄，8例患者垂体柄得到保护。10例患者术后视力改善，3例患者功能障碍恢复正常。除1例术前垂体激素功能正常的患者术后发生垂体功能减退外，术前和术后内分泌功能无显著差异。14例患者术后发生尿崩症（DI），其中6例为长期DI，其他患者报告为术后短暂性DI。未发现脑脊液（CSF）漏。无死亡或严重并发症发生。2例患者出现肥胖，随访期间无死亡及复发病例。
单纯EEE入路是治疗复发性或残留的有症状颅咽管瘤的一种安全、有效的替代方法，因其具有广角视野、密切观察和避免脑牵拉等优点。需要进行更大规模的研究并进一步随访，以评估这种微创入路的长期疗效。
