Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, China.
Department of Neurosurgery, Institute of Brain Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, China; Shenzhen Qianhai Taikang Hospital, Shenzhen, China.
Neoplasia. 2024 Nov;57:101060. doi: 10.1016/j.neo.2024.101060. Epub 2024 Oct 1.
Understanding the differences of suprasellar papillary and adamantinomatous craniopharyngiomas (PCPs/ACPs) is pivotal for target therapy, surgical strategy or postoperative management. Here, the clinical features, surgical nuances and postoperative hypothalamic outcomes of PCPs were systematically recapitulated.
24 PCPs and 52 ACPs underwent initial surgery were retrospectively reviewed. Clinical data, quantified third ventricle (3rd V) occupation and optic chiasm distortion were compared, as well as intra-operative findings, operating notes and prognosis. Moreover, analysis of tumor/3rd V relationship and hypothalamic outcomes were also performed.
Tumors were more likely to occupies the 3rd V cavity in PCPs. Chiasm distortion of "compressed forward" was the most common pattern (45.8 %) in PCPs, whereas "stretched forward" pattern accounted the highest (42.5 %) in ACPs. Besides, round-shaped with less calcification, duct-like recess, solid consistency, rare subdiaphragmatic invasion, visible lower stalk and improved postoperative visual outcome were more frequently observed in PCPs. The basal membranes of the tumor epithelium and the reactive gliosis were separated by a layer of collagen fibers in most PCPs, which differs from ACPs in the morphological examination of tumor/3rd V floor interface. In daytime sleepiness and memory difficulty, the PCPs showed significantly better outcomes than the ACPs groups, and PCPs suffered less postoperative weight gain (p < 0.05) than ACPs among adult-onset cases.
PCPs are different from ACPs regards the clinical features, operative techniques and outcomes. If necessary, PCPs are suggested more amenable to total removal since its less invasiveness to the 3rd V floor and better hypothalamic outcomes.
了解鞍上乳头型和造釉细胞瘤型颅咽管瘤（PCP/ACP）的差异对于靶向治疗、手术策略或术后管理至关重要。在这里，我们系统地总结了 PCP 的临床特征、手术细节和术后下丘脑结果。
回顾性分析了 24 例 PCP 和 52 例 ACP 患者的初始手术资料。比较了临床资料、量化的第三脑室（3rd V）占位和视交叉扭曲程度，以及术中发现、手术记录和预后。此外，还分析了肿瘤/3rd V 的关系和下丘脑结果。
PCP 更倾向于占据 3rd V 腔。PCP 中最常见的视交叉扭曲模式是“向前受压”（45.8%），而 ACP 中最高的是“向前拉伸”模式（42.5%）。此外，PCP 中更常见的是圆形、较少钙化、导管样凹陷、实性、罕见膈下侵犯、可见的垂体柄和术后视力改善。肿瘤上皮的基膜和反应性胶质增生被一层胶原纤维隔开，这与 ACP 在肿瘤/3rd V 交界处的形态学检查不同。在白天嗜睡和记忆力困难方面，PCP 组的结果明显优于 ACP 组，且在成年发病的病例中，PCP 组术后体重增加的情况较 ACP 组少（p<0.05）。
PCP 在临床特征、手术技术和结果方面与 ACP 不同。如果需要，建议对 PCP 进行更彻底的切除，因为其对 3rd V 底部的侵袭性较小，并且对下丘脑的结果更好。
