Kim Kyung Hwan, Kim Yong Hwy, Dho Yun-Sik, Kim Jung Hee, Hong Sang Duk, Choi Jung Won, Seol Ho Jun, Nam Do-Hyun, Lee Jung-Il, Park Chul-Kee, Kong Doo-Sik
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
World Neurosurg. 2018 Jun;114:e306-e316. doi: 10.1016/j.wneu.2018.02.178. Epub 2018 Mar 7.
Despite advances in endoscopic techniques, retrochiasmatic craniopharyngiomas (CPs) are difficult to remove completely, because the low-lying optic chiasm often provides an obstacle to an endoscopic endonasal approach. This study aimed to identify the endoscopic surgical outcomes of the retrochiasmatic CP and resolve the issues related to low-lying optic chiasm.
We reviewed 154 consecutive patients with CP who underwent endonasal endoscopic resection from February 2009 to April 2017 at 2 independent institutions. The topographic relationship of the tumor with the third ventricle, stalk, and optic chiasm and clinical outcomes were investigated.
Retrochiasmatic CPs were found in 142 of 154 patients (92.2%). The median follow-up time was 25 months. Gross total resection and near-total resection were achieved in 113 patients (79.6%) and 21 patients (13.8%), respectively. Postoperative cerebrospinal fluid leaks were found in 16 patients (11.3%). Low-lying and high-lying chiasms were found in 44 patients (31.0%) and 98 patients (69.0%), respectively. Low-lying chiasm did not affect clinical outcomes including the extent of resection. Patients with low-lying chiasm showed a marginal trend for postoperative visual deterioration. The ventricular growth pattern representing the origin of the tumor and previous surgery were significantly associated with the position of the optic chiasm (P = 0.007 and 0.001, respectively).
An endoscopic endonasal approach is an effective surgical approach for retrochiasmatic CP, even in tumors with low-lying chiasm. However, a thorough and careful dissection is necessary to prevent visual deterioration.
尽管内镜技术取得了进展，但视交叉后颅咽管瘤（CPs）仍难以完全切除，因为低位的视交叉常常阻碍经鼻内镜入路。本研究旨在确定视交叉后CP的内镜手术效果，并解决与低位视交叉相关的问题。
我们回顾了2009年2月至2017年4月在2家独立机构接受经鼻内镜切除的154例连续CP患者。研究了肿瘤与第三脑室、垂体柄和视交叉的位置关系以及临床结果。
154例患者中有142例（92.2%）发现视交叉后CP。中位随访时间为25个月。分别有113例（79.6%）和21例（13.8%）实现了全切除和近全切除。16例患者（11.3%）出现术后脑脊液漏。分别有44例（31.0%）和98例（69.0%）发现低位和高位视交叉。低位视交叉不影响包括切除范围在内的临床结果。低位视交叉患者术后视力恶化呈边缘性趋势。代表肿瘤起源的脑室生长模式和既往手术与视交叉位置显著相关（P分别为0.007和0.001）。
经鼻内镜入路是治疗视交叉后CP的有效手术方法，即使是对视交叉低位的肿瘤也是如此。然而，为防止视力恶化，需要进行彻底且仔细的解剖。
