Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, Toronto, Canada.
Department of Neurosurgery, Northshore University Hospital, Northwell Health, Manhasset, New York.
Oper Neurosurg (Hagerstown). 2019 Aug 1;17(2):132-142. doi: 10.1093/ons/opy356.
The role of expanded endonasal endoscopic surgery for primary and recurrent craniopharyngioma is not yet fully established.
To report and evaluate our experience with the endoscopic endonasal approach (EEA) for the resection of primary and recurrent craniopharyngiomas.
This is a retrospective cohort analysis of 43 consecutive EEA procedures in 40 patients operated from September 2006 to February 2012 for suprasellar craniopharyngiomas. In 21 patients (48.8%) the disease was recurrent. We have assessed the surgical results, visual, endocrinological, and functional outcomes and resection rates in this patient cohort.
At presentation, 31 (72.1%) patients had visual deficits, 15 patients (34.9%) complained of headaches, 25 patients (58.1%) had anterior pituitary insufficiency, and 14 (32.5%) had diabetes insipidus. Total resection was achieved in 44.2% surgeries, of which 77.3% were in primary lesions and 9.5% in recurrent lesions (P < .001). Vision improved in 92.6% patients and worsened in 2.3%. Complications other than vision were encountered in 25.6% including 9/43 cerebrospinal fluid leak, 2/43 meningitis. A total of 51.9% of patients with preoperative residual anterior pituitary function had new anterior pituitary deficiencies and 42.8% had new diabetes insipidus. There was no mortality. Six patients (14%) had recurrence of disease during the follow-up period (mean 56.8 mo), 5 of which required repeat surgery.
The EEA can be integrated in the overall management of both primary and recurrent craniopharyngiomas with good results; however, in our series recurrent surgery was associated with significantly lower rates of gross total resection.
扩大经鼻内镜手术在原发性和复发性颅咽管瘤中的作用尚未完全确定。
报告并评估我们经内镜鼻内入路（EEA）切除原发性和复发性颅咽管瘤的经验。
这是一项回顾性队列分析，纳入了 2006 年 9 月至 2012 年 2 月期间连续 43 例接受内镜经鼻入路手术的 40 例患者，这些患者均为鞍上颅咽管瘤。21 例（48.8%）患者为复发性疾病。我们评估了该患者队列的手术结果、视力、内分泌和功能结果以及切除率。
在就诊时，31 例（72.1%）患者存在视力障碍，15 例（34.9%）患者有头痛，25 例（58.1%）患者存在前叶垂体功能不足，14 例（32.5%）患者存在尿崩症。44.2%的手术实现了全切，其中原发性病变全切率为 77.3%，复发性病变全切率为 9.5%（P<.001）。92.6%的患者视力改善，2.3%的患者视力恶化。除视力以外的并发症发生率为 25.6%，包括 43 例中有 9 例发生脑脊液漏，43 例中有 2 例发生脑膜炎。术前有残余前叶垂体功能的患者中，51.9%出现新的前叶垂体功能不足，42.8%出现新的尿崩症。无死亡病例。6 例（14%）患者在随访期间（平均随访时间为 56.8 个月）疾病复发，其中 5 例需要再次手术。
EEA 可纳入原发性和复发性颅咽管瘤的综合治疗中，效果良好；然而，在我们的研究中，复发性手术与全切率显著降低相关。
