Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
J Neurooncol. 2022 Sep;159(3):597-607. doi: 10.1007/s11060-022-04099-0. Epub 2022 Aug 4.
Children with craniopharyngiomas (CP) can experience significant morbidities caused by extensive surgery and/or radiation. Ommaya reservoir insertion (ORI) into cystic CP represents a minimally invasive approach allowing immediate decompression and aims to avoid additional injuries. The purpose of this study was to determine the surgical outcome and relevance of upfront ORI (± intracystic treatment) for preservation of endocrine function.
We performed a retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020. Endocrine function was reviewed at the time of initial surgery and throughout follow-up. New endocrinological deficits related to the index procedure were defined as immediate failure (IF), whereas postoperative duration of endocrinological stability (ES) was analyzed using the Kaplan-Meier method. The rate of IF and ES was compared between the treatment groups.
Seventy-nine patients were included and had a median age of 8.3 years (range 2.1-18.0 years); 31 were males. Fifty-three patients with upfront surgical treatment, including 29 ORI and 24 gross total or partial resections had sufficient endocrinological follow-up data. Endocrine dysfunction occurring immediately after the index procedure (IF) was observed in 15 patients (62.5%) in the resection group compared to two patients (6.8%) in the ORI group, odds ratio: 0.05 (CI: 0.01-0.26, p < 0.0001). Excluding those with immediate endocrinological deficits, mean ES after ORI was 19.4 months (CI: 11.6-34.2), compared to 13.4 months (CI:10.6-NA) after surgical resection.
Endocrine function was preserved in patients with upfront ORI (± intracystic treatment), which was confirmed as a minimally invasive procedure with an overall low morbidity profile.
颅咽管瘤（CP）患儿可因广泛手术和/或放疗引起显著的发病率。将奥马亚储液器（ORI）插入囊性 CP 代表一种微创方法，可立即减压，并旨在避免额外的损伤。本研究的目的是确定即刻 ORI（±囊内治疗）保留内分泌功能的手术结果和相关性。
我们对 2000 年 1 月 1 日至 2020 年 1 月 15 日期间在多伦多 SickKids 医院接受治疗的 CP 患儿进行了回顾性图表审查。在初次手术时和整个随访期间回顾内分泌功能。与指数手术相关的新内分泌缺陷定义为即刻失败（IF），而术后内分泌稳定（ES）的持续时间则使用 Kaplan-Meier 方法进行分析。比较了治疗组之间 IF 和 ES 的发生率。
共纳入 79 例患者，中位年龄为 8.3 岁（范围 2.1-18.0 岁）；男性 31 例。53 例患者进行了初步手术治疗，其中 29 例行 ORI，24 例行大体全切除或部分切除，有足够的内分泌随访数据。在切除组中，15 例（62.5%）患者在指数手术后立即出现内分泌功能障碍（IF），而 ORI 组中仅 2 例（6.8%）患者出现 IF，比值比：0.05（CI：0.01-0.26，p<0.0001）。排除那些有即刻内分泌缺陷的患者后，ORI 后的平均 ES 为 19.4 个月（CI：11.6-34.2），而手术切除后的 ES 为 13.4 个月（CI：10.6-NA）。
在进行了初步 ORI（±囊内治疗）的患者中保留了内分泌功能，证实这是一种微创方法，总体发病率较低。
