Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.
China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China.
Neurosurg Rev. 2023 Sep 11;46(1):238. doi: 10.1007/s10143-023-02146-6.
This study aimed to investigate the therapeutic efficacy of three different surgical approaches for the treatment of intraventricular craniopharyngiomas (IVCs). The three surgical approaches investigated in this study were the endoscopic endonasal approach (EEA), pterional trans-lamina terminalis approach (PTA), and interhemispheric trans-lamina terminalis approach (ITA). Patient demographics, preoperative symptoms, endocrine and hypothalamic status, tumor characteristics, and surgical outcomes were analyzed and compared among the different surgical groups. A total of 31 patients with IVCs were included in the analysis, with 12 patients in the EEA group, 8 patients in the ITA group, and 11 patients in the PTA group. The mean follow-up time was 39 ± 23 months. Statistical analysis of the data revealed significant differences in the gross total resection (GTR) rate among the three surgical groups (P = 0.033). The GTR rate for the EEA group was 100%, that for the ITA group was 88%, and that for the PTA group was 64%, which was the lowest rate observed. After surgery, only 8.3% of the patients in the EEA group did not experience new postoperative hypopituitarism, while the percentages in the ITA and PTA groups were 75% and 73%, respectively (P = 0.012). Finally, we found that postoperative hypopituitarism may be related to the transection of the pituitary stalk during the operation (P = 0.020). Based on the results of this study, we recommend using the EEA and the ITA instead of the PTA for the surgical resection of IVCs. Furthermore, the appropriate surgical approach should be selected based on the tumor's growth pattern.
本研究旨在探讨三种不同手术入路治疗脑室颅咽管瘤（IVC）的疗效。本研究中研究的三种手术入路为内镜经鼻入路（EEA）、翼点经终板入路（PTA）和半球间经终板入路（ITA）。分析和比较了不同手术组患者的人口统计学资料、术前症状、内分泌和下丘脑状态、肿瘤特征和手术结果。共纳入 31 例 IVC 患者，其中 EEA 组 12 例，ITA 组 8 例，PTA 组 11 例。平均随访时间为 39±23 个月。数据分析显示，三种手术组的大体全切除（GTR）率存在显著差异（P=0.033）。EEA 组的 GTR 率为 100%，ITA 组为 88%，PTA 组为 64%，为最低。手术后，只有 EEA 组 8.3%的患者没有发生新的术后垂体功能减退，而 ITA 组和 PTA 组的百分比分别为 75%和 73%（P=0.012）。最后，我们发现术后垂体功能减退可能与手术过程中垂体柄的横断有关（P=0.020）。基于本研究的结果，我们建议使用 EEA 和 ITA 代替 PTA 来切除 IVC。此外，应根据肿瘤的生长模式选择合适的手术入路。
