Wu Danyang, Xu Ling, Xie Sungel, Sun Feiji, Xie Mingxiang, Wang Pei, Xiao Shunwu
Department of Neurosurgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Graduate School, Zunyi Medical University, Zunyi, China.
Front Neurol. 2022 Jan 31;13:771236. doi: 10.3389/fneur.2022.771236. eCollection 2022.
To explore the surgical approach and technique of neuroendoscopic endonasal resection of pediatric craniopharyngiomas and to further evaluate its safety and effect in children.
The clinical data of 8 children with craniopharyngiomas who were surgically treated by neuroendoscopy through an extended endonasal approach in our center from 2018 to 2021 were retrospectively analyzed. The related surgical approach and technique were evaluated to improve the surgical results and further reduce the surgical complications when removing craniopharyngioma in children.
All 8 patients achieved a gross-total resection of the tumor under neuroendoscopy. Postoperatively, 2 cases of transient hyperthermia and 4 cases of transient hyper- and/or hyponatremia occurred within the first 2 weeks, all of which were quickly controlled. Seven patients had symptoms of diabetes insipidus to varying degrees after the operation, and 4 of them improved within 1-3 months after surgery, but 3 cases still needed oral pituitrin. There were no cases of coma or death, leakage of cerebrospinal fluid, or severe electrolyte imbalance after surgery. During the postoperative follow-up of 3 months to 2 years, no tumor recurrence was found. Among the 7 patients who suffered postoperative neuroendocrine deficiencies, 3 patients were found to be temporary during the follow-up, but 4 patients still required hormone replacement therapy. Particularly, postoperative visual deterioration and olfactory defect that occurred in patients were all improved during follow-up periods. In addition, 4 cases of obesity were noted at the last follow-up.
Extended neuroendoscopic endonasal resection of craniopharyngiomas may be used as a safe and effective approach for children. Due to the poor pneumatization of the sphenoid sinus and worse compliance of treatment in children, surgical techniques of exposing the sellar region, removing the tumor, and reconstructing the skull base, as well as postoperative management of patients was proposed. However, due to the limited surgical cases in the study, the surgical safety and effects of the extended neuroendoscopic endonasal approach for children with craniopharyngiomas need to be further studied in the future.
探讨神经内镜经鼻入路切除小儿颅咽管瘤的手术方法及技巧，并进一步评估其在儿童中的安全性及疗效。
回顾性分析2018年至2021年在本中心采用神经内镜经鼻扩大入路手术治疗的8例小儿颅咽管瘤患者的临床资料。评估相关手术方法及技巧，以提高手术效果，并在切除小儿颅咽管瘤时进一步减少手术并发症。
8例患者均在神经内镜下实现肿瘤全切除。术后2周内，2例出现短暂性高热，4例出现短暂性高钠血症和/或低钠血症，均迅速得到控制。7例患者术后出现不同程度的尿崩症症状，其中4例在术后1 - 3个月内好转，但3例仍需口服垂体后叶素。术后无昏迷或死亡、脑脊液漏或严重电解质紊乱病例。术后3个月至2年的随访期间，未发现肿瘤复发。在7例术后出现神经内分泌功能减退的患者中，随访发现3例为暂时性，但4例仍需激素替代治疗。特别是，患者术后出现的视力减退和嗅觉缺陷在随访期间均有改善。此外，末次随访时发现4例肥胖。
神经内镜经鼻扩大入路切除颅咽管瘤可作为儿童安全有效的手术方法。由于儿童蝶窦气化不良及治疗依从性较差，提出了鞍区暴露、肿瘤切除及颅底重建的手术技巧以及患者的术后管理。然而，由于本研究手术病例有限，神经内镜经鼻扩大入路治疗小儿颅咽管瘤的手术安全性及效果有待今后进一步研究。
