Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia.
Department of Neurosurgery, Sir Charles Gairdner Hospital (SCGH), Perth, WA, Australia.
J Clin Neurosci. 2020 Nov;81:436-441. doi: 10.1016/j.jocn.2020.07.053. Epub 2020 Oct 26.
Endoscopic endonasal approach (EEA) has recently been proposed as an option for resection of primary and recurrent suprasellar craniopharyngioma. However, surgical outcome has not yet been fully evaluated, especially in regards to recurrent cases.
We analysed our institution (Sir Charles Gairdner University Hospital, Perth, Australia) case-series retrospectively. There were 16 patients operated through an endonasal endoscopic approach from February 2014 to February 2019 for suprasellar craniopharyngiomas. There were 14 primary, and two recurrent lesions. Extent of resection, complications, visual and endocrinological outcomes are presented.
Mean age of the patients was 42.9 ± 19.3 years old, with 56% female. The most common clinical symptoms were headaches (9 patients, 56%) and bi-temporal hemianopsia (9 patients, 56%), followed by unilateral optic neuropathy (5 cases, 31%), memory loss (1 case, 6%), hydrocephalus (1 case, 6%), delayed growth and puberty (1 case, 6%), and secondary amenorrhoea (1 case, 6%). Only two cases (12%) initially presented with normal visual function. Gross total resection (GTR) was achieved in 10/16 patients (62.5%), with subtotal resection (STR) in the remainder. Visual symptoms improved in 13/16 patients (81%) and remained unchanged in 3/16 patients (19%). Most common complications included new endocrinological deficit in nine patients (56%), mostly diabetes insipidus, and cerebrospinal fluid leak requiring a new intervention in three patients (19%). There was one mortality case (complicated meningitis, stroke and vasospasm). Mean follow-up time was 22.05 ± 14 months and three patients (19%) had a recurrence of the disease during this period and were referred for radiation therapy.
Endonasal endoscopic approach is a safe and effective surgical option for both primary and recurrent suprasellar craniopharyngiomas.
内镜经鼻入路（EEA）最近被提议作为切除原发性和复发性鞍上颅咽管瘤的一种选择。然而，手术结果尚未得到充分评估，尤其是在复发病例方面。
我们回顾性分析了我们机构（澳大利亚珀斯查尔斯·盖尔德纳大学医院）的病例系列。从 2014 年 2 月至 2019 年 2 月，共有 16 例患者通过内镜经鼻入路手术治疗鞍上颅咽管瘤。其中原发性 14 例，复发性 2 例。介绍了切除程度、并发症、视力和内分泌学结果。
患者的平均年龄为 42.9±19.3 岁，女性占 56%。最常见的临床症状是头痛（9 例，56%）和双颞侧偏盲（9 例，56%），其次是单侧视神经病变（5 例，31%）、记忆力减退（1 例，6%）、脑积水（1 例，6%）、生长和青春期延迟（1 例，6%）和继发性闭经（1 例，6%）。仅有 2 例（12%）患者最初表现为正常视力。10/16 例（62.5%）患者达到全切除（GTR），其余患者行次全切除（STR）。16 例患者中有 13 例（81%）视力症状改善，3 例（19%）无变化。最常见的并发症包括 9 例（56%）新的内分泌缺陷，主要是尿崩症，3 例（19%）患者需要新的干预以治疗脑脊液漏。有 1 例死亡病例（并发脑膜炎、中风和血管痉挛）。平均随访时间为 22.05±14 个月，在此期间有 3 例（19%）患者疾病复发，并转介行放疗。
内镜经鼻入路是治疗原发性和复发性鞍上颅咽管瘤的一种安全有效的手术选择。
