Nie Chuansheng, Ye Youfan, Wu Jingnan, Zhao Hongyang, Jiang Xiaobing, Wang Haijun
Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Feb 10;12:755342. doi: 10.3389/fonc.2022.755342. eCollection 2022.
Craniopharyngioma has always been a challenge for the neurosurgeon, and there is no consensus on optimal treatment. The objective of this study was to compare surgical outcomes and complications between transcranial surgery (TCS) and endoscopic endonasal surgery (EES) of craniopharyngiomas.
A retrospective review of patients who underwent craniopharyngioma resection at Wuhan Union Hospital between January 2010 and December 2019 was performed. A total of 273 patients were enrolled in this retrospective study. All patients were analyzed with surgical effects, endocrinologic outcomes, complications, and follow-up results.
A total of 185 patients underwent TCS and 88 underwent EES. There were no significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between the two groups. The mean follow-up was 30.5 months (range 8-51 months). The EES group had a greater gross total resection (GTR) rate (89.8% EES vs. 77.3% TCS, p < 0.05) and lower rate of hypopituitarism (53.4% EES vs. 68.1% TCS, p < 0.05) and diabetes insipidus (DI) (51.1% EES vs. 72.4% TCS, p < 0.05). More postoperative cerebrospinal fluid (CSF) leaks occurred in the EES group (4.5% EES vs. 0% TCS, p < 0.05). More patients in the EES group with preoperative visual deficits experienced improvement after surgery (74.5% EES vs. 56.3% TCS, p < 0.05). There were statistical differences in the recurrence rates (12.5% EES vs. 23.8% TCS, p < 0.05) between the 2 groups.
These data support the view that EES is a safe and effective minimally invasive surgery compared to TCS. Compared to TCS, EES has fewer surgical complications and a lower recurrence rate.
颅咽管瘤一直是神经外科医生面临的挑战，对于最佳治疗方案尚无共识。本研究的目的是比较颅咽管瘤经颅手术（TCS）和鼻内镜手术（EES）的手术效果及并发症。
对2010年1月至2019年12月在武汉协和医院接受颅咽管瘤切除术的患者进行回顾性研究。本回顾性研究共纳入273例患者。对所有患者的手术效果、内分泌学结果、并发症及随访结果进行分析。
185例患者接受了TCS，88例接受了EES。两组患者的人口统计学数据、术前症状和肿瘤特征无显著差异。平均随访时间为30.5个月（范围8 - 51个月）。EES组的全切除率更高（EES组为89.8%，TCS组为77.3%，p < 0.05），垂体功能减退率（EES组为53.4%，TCS组为68.1%，p < 0.05）和尿崩症（DI）发生率（EES组为51.1%，TCS组为72.4%，p < 0.05）更低。EES组术后脑脊液漏发生率更高（EES组为4.5%，TCS组为0%，p < 0.05）。EES组术前有视力障碍的患者术后改善情况更好（EES组为74.5%，TCS组为56.3%，p < 0.05）。两组的复发率有统计学差异（EES组为12.5%，TCS组为23.8%，p < 0.05）。
这些数据支持以下观点，即与TCS相比，EES是一种安全有效的微创手术。与TCS相比，EES手术并发症更少，复发率更低。
