Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Pituitary. 2019 Apr;22(2):146-155. doi: 10.1007/s11102-019-00945-z.
Hypophysial and hypothalamic dysfunction caused by craniopharyngioma is a serious problem despite the progress of surgical approaches and techniques. Perifocal edema induced by craniopharyngioma could be speculated as a potential factor resulting in pre- and post-operative hypophysial and hypothalamic dysfunction, as well as, their anatomical involvement.
Medical records of 54 patients with craniopharyngioma were retrospectively reviewed. The edema was characterized by a hyperintense area in magnetic resonance imaging, being classified into no edema (group A), only adjacent to the tumor (group B), and extending to the internal capsule or the optic tract (group C). Age, sex, tumor diameter, presence of cyst, hydrocephalus, intracranial pressure (ICP) elevation, visual function impairment, hypopituitarism, diabetes insipidus, memory disturbance, and obesity were investigated.
The occurrence rate of edema was found more frequently in adults (73.7%) than in children (25.0%). The peritumoral edema grading system had an excellent correlation with the degree of hypothalamic involvement graded by the Puget's system. Pre-operative ICP elevation was significantly detected in group C when compared with the other groups. In adults patients, group C was significantly associated with the occurrence of hydrocephalus both in pre- and post-operatively. Pre- and post-operative hypothalamic dysfunction, including diabetes insipidus, memory disturbance, and obesity, were highest in group C.
Hypothalamic dysfunctions greatly influence the quality of daily living following craniopharyngioma surgery. The grading of perifocal edema's extension could be a new index suggesting pre- and post-operative hypothalamic dysfunction caused by craniopharyngioma in addition to their anatomical involvement.
尽管手术方法和技术不断进步，但颅咽管瘤引起的垂体和下丘脑功能障碍仍然是一个严重的问题。颅咽管瘤引起的瘤周水肿可能是导致术前和术后垂体和下丘脑功能障碍及其解剖学受累的潜在因素。
回顾性分析 54 例颅咽管瘤患者的病历资料。水肿在磁共振成像上表现为高信号区域，分为无水肿（A 组）、仅与肿瘤相邻（B 组）和延伸至内囊或视束（C 组）。分析年龄、性别、肿瘤直径、囊变、脑积水、颅内压升高、视力障碍、垂体功能减退、尿崩症、记忆障碍和肥胖等因素。
水肿的发生率在成人（73.7%）中明显高于儿童（25.0%）。瘤周水肿分级系统与 Puget 系统分级的下丘脑受累程度具有极好的相关性。与其他两组相比，C 组术前颅内压升高更为明显。在成人患者中，C 组与术前和术后脑积水的发生显著相关。术前和术后下丘脑功能障碍，包括尿崩症、记忆障碍和肥胖，在 C 组中发生率最高。
下丘脑功能障碍极大地影响颅咽管瘤手术后的日常生活质量。瘤周水肿延伸的分级可能是除了解剖学受累之外，另一个提示颅咽管瘤引起的术前和术后下丘脑功能障碍的新指标。
