Honegger J, Buchfelder M, Fahlbusch R
Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
J Neurosurg. 1999 Feb;90(2):251-7. doi: 10.3171/jns.1999.90.2.0251.
This study aimed to elucidate the endocrinological outcome of craniopharyngioma surgery. In particular, endocrinological results were analyzed in relation to the surgical approach. The study includes 143 patients who underwent pre- and postoperative endocrinological assessment and who had not previously undergone surgery.
Diabetes insipidus was the most common postoperative deficiency in both the transcranial and transsphenoidal groups. The overall percentage of patients with diabetes insipidus increased from 16.1% preoperatively to 59.4% postoperatively. After transcranial surgery, the rate of anterior pituitary deficiency also increased. However, normal preoperative anterior pituitary function was maintained in more than 50% of patients for each endocrine axis. Similar results were attained in the group of patients undergoing complete tumor removal. The best result was achieved for gonadal function: the incidence of hypogonadism increased only slightly from 77.4 to 79.8%. The rate of anterior pituitary failure at presentation was much higher in the transsphenoidal than in the transcranial group. During transsphenoidal surgery, intact anterior pituitary functions were generally preserved. The rate of panhypopituitarism increased only slightly, from 40% before surgery to 42.9% after surgery. Endocrinological results were not inferior in patients with a ventrally displaced pituitary. This variant required midline incision of the gland for exposure of the craniopharyngioma. In the entire series of 143 patients the pituitary stalk was generally preserved. Postoperative panhypopituitarism was encountered in only one of eight patients in whom the pituitary stalk was partially resected because of tumor infiltration. None of the 88 patients who remained recurrence-free demonstrated endocrinological deterioration during follow-up review, compared with the early postoperative assessment 3 months postsurgery. On the other hand, complete recovery of one endocrine axis was observed in nine of these patients during later follow-up evaluations. In five of them, diabetes insipidus had regressed.
It is worth preserving the pituitary stalk and gland at surgery because of the definite chance that intact anterior pituitary functions can be maintained. Postoperative diabetes insipidus must be accepted as a common sequela following attempts at complete removal of the craniopharyngioma.
本研究旨在阐明颅咽管瘤手术的内分泌学结果。特别是，分析了与手术入路相关的内分泌学结果。该研究纳入了143例接受术前和术后内分泌学评估且此前未接受过手术的患者。
尿崩症是经颅组和经蝶组术后最常见的缺乏症。尿崩症患者的总体百分比从术前的16.1%增加到术后的59.4%。经颅手术后，垂体前叶功能减退的发生率也增加。然而，每个内分泌轴超过50%的患者术前垂体前叶功能正常得以维持。肿瘤完全切除的患者组也取得了类似结果。性腺功能的结果最佳：性腺功能减退的发生率仅从77.4%略有增加至79.8%。经蝶组术前垂体前叶功能衰竭的发生率远高于经颅组。在经蝶手术过程中，垂体前叶的完整功能通常得以保留。全垂体功能减退的发生率仅略有增加，从手术前的40%增至手术后的42.9%。垂体向下移位的患者内分泌学结果并不差。这种变异需要在腺体中线切开以暴露颅咽管瘤。在整个143例患者系列中，垂体柄通常得以保留。在8例因肿瘤浸润而部分切除垂体柄的患者中，仅1例出现术后全垂体功能减退。在术后3个月进行早期术后评估后，88例无复发患者在随访复查期间均未出现内分泌学恶化。另一方面，在这些患者的后期随访评估中，有9例患者的一个内分泌轴完全恢复。其中5例患者的尿崩症已消退。
手术时保留垂体柄和腺体是值得的，因为有一定机会维持垂体前叶完整功能。术后尿崩症必须被视为完全切除颅咽管瘤后常见的后遗症。
