手术切除颅咽管瘤后的长期随访

目的探讨颅咽管瘤手术切除后的长期疗效。方法回顾性分析117例随访3年以上的颅咽管瘤术后病人的临床资料。采用翼点入路手术78例,额底纵裂入路33例,额下入路6例。对术后生活质量、多饮多尿、性功能、肿瘤复发、术后治疗,死亡原因等进行随访评价。结果肿瘤全切除109例,近全切除8例。术中垂体柄保留65例,垂体柄离断14例,未见垂体柄38例。恢复正常生活和工作者97例(82.9%),生活自理9例(7.7%),生活需要照顾5例(4.3%),死亡6例(5.1%),其中3例死于下丘脑功能低下,1例死于高钠血症,1例死于肝病,1例死于血液病。持续尿崩症26例(22.0%)。肿瘤复发28例(23.9%),复发肿瘤位于鞍内4例,鞍上10例,鞍旁9例,第三脑室内3例,外侧裂和额底2例。46例成年男性病人中有勃起和射精功能10例(21.7%),41例成年女性病人中有正常月经及生育8例(19.5%)。结论手术全切除颅咽管瘤能使大部分病人得到长期正常的生活,但术后肿瘤复发和需要激素替代治疗仍是值得关注的问题。     

经终板入路显微外科手术切除视交叉后颅咽管瘤

目的 探讨经终板入路显微外科手术切除视交叉后累及第三脑室颅咽管瘤的可行性、手术技巧及疗效.方法 回顾性分析34例位于视交叉后累及第三脑室颅咽管瘤病人的临床资料,均采用经终板入路显微手术切除肿瘤.结果 肿瘤全切除30例,次全切除4例.本组死亡1例.术后出现尿崩症、电解质紊乱、垂体前叶功能低下等并发症.术前症状多数不同程度好转.23例随访3～7年,次全切除的病人中术后行伽玛刀治疗3例,随访期间未复发;拒绝放疗1例,术后16个月MRI示肿瘤复发.另19例肿瘤全切除病人随访期间均未复发.结论 经终板入路切除视交叉后累及第三脑室的颅咽管瘤,可取得较好的疗效;精湛的显微外科技巧可避免或减少发生术后并发症.     

经眶上外侧入路显微手术切除颅咽管瘤26例临床分析

目的探讨眶上外侧入路在颅咽管瘤显微手术临床运用中的安全性及有效性。方法回顾性分析26例经眶上外侧入路显微手术的颅咽管瘤病人术前症状、影像学检查、手术治疗及随访情况,总结相关手术技巧。结果肿瘤手术全切除21例(80.8%),次全切除4例(15.4%),部分切除1例(3.8%),无死亡病例。18例术前视力减退的病人中,明显好转12例,无明显变化5例,较前下降1例;术后未见新增视力障碍。无开颅相关并发症。随访3~60个月,恢复正常工作生活21例(80.8%),生活自理3例(11.5%),需他人照顾2例(7.7%);肿瘤复发4例(15.4%),无死亡病例。结论应用眶上外侧入路能安全、有效地切除颅咽管瘤,是一种简便易行、微创的手术方式,值得推广应用。     

儿童颅咽管瘤的显微外科治疗

目的 探讨儿童颅咽管瘤显微外科治疗的手术方法、手术入路和治疗效果。方法 回顾性分析33例儿章颅咽管瘤患者显微外科治疗的临床资料。结果 33例中肿瘤全切除30例，近全切除3例，无手术死亡及严重并发症，近全切者术后辅助立体定向放射治疗。31例获随访17月～8．1年，平均4．8年。效果良好者28例，需生活照顾者3例，MRI／CT复查未见肿瘤复发。结论 显微手术切除肿瘤是儿童颅咽管瘤有效的治疗措施；额颞-眶入路能明显缩短到达肿瘤的距离，能显著提高颅咽管瘤手术切除效果。     

颅咽管瘤术后并发症的防治

目的探讨颅咽管瘤切除术后并发症的特点和处理原则。方法回顾性分析82例颅咽管瘤病人的临床资料,均经手术治疗,术后监测水、电解质和血糖变化,并记录24 h尿量。结果肿瘤全切除75例,次全切除7例。颅咽管瘤术后并发症较多,其中尿崩症78例,钠代谢紊乱74例,垂体功能低下67例,高热17例,精神障碍11例,意识障碍4例,深静脉血栓4例,癫癎3例。随访17-36个月,平均28个月,恢复正常生活和学习68例,仅能生活自理8例,不能生活自理4例,死亡2例。结论颅咽管瘤术后并发症较多,早期监测和及时处理可进一步提高该病的治愈率。     

颅咽管瘤手术的临床研究

目的研究手术切除颅咽管瘤的方法和疗效。方法在显微镜的辅助下对64例颅咽管瘤患者进行手术,术中根据肿瘤与周围重要神经、血管、三脑室、蝶鞍、垂体柄的位置关系以及粘连情况来具体决定切除程度,对于不易全切的囊性、囊实性肿瘤术毕瘤腔内置入Ommaya管,术后瘤腔注入96钇进行内放射治疗。结果经术中观察和影像学证实,17例全切,47例次全或部分切除加置Ommaya管内放射治疗,出院后随访6个月~1 a,能工作学习或生活自理56例,生活需照顾8例,无死亡病例。结论在严格保护下丘脑功能的前提下,对于不易全切的颅咽管瘤,不盲目追求肿瘤全切,术中放置Ommaya管术后继续内放射治疗,并发症少,病人生活质量得到明显改善。     

经鼻蝶入路神经内镜手术治疗颅咽管瘤50例体会

目的 探讨经鼻蝶入路神经内镜手术治疗颅咽管瘤的疗效。方法 回顾性分析2014年7月至2020年3月经鼻蝶入路神经内镜手术切除的50例颅咽管瘤的临床资料。结果 肿瘤全切除48例（96.0%），次全切除2例。86.36%的病人术后视力改善，95.24%的病人术后认知功能改善。术后40例出现全垂体功能减退，9例内分泌功能正常，1例出现生长激素缺乏。术后38例（76.0%）出现尿崩症。术后发生脑脊液漏2例，颅内感染7例。50例中位随访时间为32.0个月，随访期间无死亡病例，2例肿瘤复发。结论 经鼻蝶入路神经内镜手术治疗颅咽管瘤，肿瘤全切除率高，术后疗效较好。     

颅咽管瘤手术的临床研究

目的研究手术切除颅咽管瘤的方法和疗效。方法在显微镜的辅助下对64例颅咽管瘤患者进行手术,术中根据肿瘤与周围重要神经、血管、三脑室、蝶鞍、垂体柄的位置关系以及粘连情况来具体决定切除程度,对于不易全切的囊性、囊实性肿瘤术毕瘤腔内置入Ommaya管,术后瘤腔注入96钇进行内放射治疗。结果经术中观察和影像学证实,17例全切,47例次全或部分切除加置Ommaya管内放射治疗,出院后随访6个月~1 a,能工作学习或生活自理56例,生活需照顾8例,无死亡病例。结论在严格保护下丘脑功能的前提下,对于不易全切的颅咽管瘤,不盲目追求肿瘤全切,术中放置Ommaya管术后继续内放射治疗,并发症少,病人生活质量得到明显改善。     

29例大型颅咽管瘤的显微外科治疗

目的探讨手术切除大型颅咽管瘤的有效方法。方法对29例经显微手术切除的大型颅咽管瘤患者的临床资料进行回顾性分析,肿瘤位于鞍上者15例,进入第三脑室者8例,位于鞍上鞍内者6例。有明显钙化18例,无明显钙化11例。囊性肿瘤24例,实质性肿瘤5例。经右翼点入路手术切除23例,经纵裂-胼胝体入路手术切除6例。结果肿瘤全切27例,次全切2例;死亡2例。所有患者术后均有不同程度的一过性尿崩症,水电解质紊乱27例,动眼神经麻痹5例。27例平均随访3年,复发3例,余能正常生活学习。结论翼点入路是鞍区大型颅咽管瘤手术的首选入路,绝大多数患者可达到肿瘤全切和良好预后。     

经额下终板入路显微切除颅咽管瘤

目的探讨手术全切除颅咽管瘤的有效方法。方法10例视交叉前置型或突入三脑室前部的颅咽管瘤,采用经终板入路,术中在显微镜下切除肿瘤,并注意保护下丘脑神经结构和防止穿通动脉的损伤。结果9例患者达到肿瘤全切除,1例次全切除。术后9例正常生活,1例患者术后生活自理。随访14个月至5年未见肿瘤复发,视力视野都有不同程度的改善。结论经额下终板入路显微切除视交叉前置型或突入三脑室前部的颅咽管瘤,术中注意保护下丘脑结构和穿支动脉,术后可以取得满意疗效。     

颅咽管瘤术后并发症与机制探讨

目的分析颅咽管瘤的治疗结果和并发症，探讨其发生机制。方法回顾性分析56例颅咽管瘤病人的治疗效果和随访情况。结果各种治疗方法均具有相应的并发症和复发可能，总病死率12．5％。下丘脑损害后症状复杂，发生率60．7％：垂体功能低下发生率48．2％；术后视力减退发生率14-3％。其他并发症还有无菌性脑膜炎、脑脊液鼻漏、暂时性偏瘫、缄默性失语、创伤性动脉瘤、癫痫等。平均随访1．98年，复发率17．9％.结论颅咽管瘤并发症发生率高，机制复杂；采用微创治疗手段可提高疗效。     

Radiological findings following postsurgical intratumoral bleomycin injection for cystic craniopharyngioma

OBJECTIVES: The purpose of this study was to compare the radiological findings before and after intratumoral bleomycin injection in patients with cystic craniopharyngioma so as to define the role of adjuvant intracavitary bleomycin chemotherapy for cystic craniopharyngiomas. PATIENTS AND METHODS: Eleven patients whose craniopharyngioma was confirmed cytologically and/or histologically were retrospectively reviewed. The follow-up duration ranged from 9 to 79 months (mean, 31.6 months). Only the solid portion of the cystic craniopharyngiomas was excised before repeated injections of bleomycin (15-180 mg in total) into the cystic portion through an Ommaya reservoir were given. The patients were evaluated neuroradiologically before and after bleomycin administration. RESULTS: After the completion of all treatment cycles, the disappearance or shrinkage of the tumor was initially noted in all cases on follow-up CT and/or MR imaging studies. However, tumor recurrence was seen in four cases with a mixed tumor type. CONCLUSION: Postoperative bleomycin injection in cystic craniopharyngioma does not appear to totally eradicate the tumor and does not stop tumor recurrence unless the cyst is the only portion of the craniopharyngioma that is left. Nevertheless, postoperative bleomycin injection decreases and stabilizes tumor size, and thus may be considered as an option of treatment modalities in patients with predominantly cystic craniopharyngiomas.     

Craniopharyngiomas—a summary of 85 cases

The results of treating 85 patients suffering from craniopharyngioma are reviewed. The recurrence of the tumour after 20 symptom-free years after radical excision is reported. Claims for successful treatment of this illness should be reviewed in this light.     

Craniopharyngiomas in children: recurrence,reoperation and outcome

Introduction Craniopharyngioma bears a high rate of recurrence and morbidity in childhood. Although the outcome after recurrence and reoperation is an important parameter for the long-term evaluation of craniopharyngioma, it is poorly documented in literature. Materials and methods We studied children reoperated for recurrent craniopharyngioma in our institution since the advent of computed tomography (CT) scanner. Reoperation for tumor resection was decided whenever the recurrence was solid, with the aim total resection if possible and reasonable. Stereotactic techniques were used in case of cystic recurrence, and external irradiation was used only in case of recurrent tumor not amenable to surgery. Results From September 1981 to January 2007, we performed one or more reoperations in 20 children presenting with recurrent craniopharyngiomas. The total number of reoperations was 29: resection was total in 12 cases, near-total in 8 cases, partial in 8 cases, and undocumented in 1. In addition, stereotactic procedures were performed in 11 cases, and 5 patients underwent external irradiation. Discussion No patient died after surgery or because of tumor progression; one patient died abruptly of an undiagnosed cause during external irradiation. The event-free survival after reoperation was 49.9% at 5years and 40.0% at 10years. At last control, after a mean follow-up of 70.4months after the last surgery, nine patients were tumor-free and ten had stable disease. Conclusion Reoperation for recurrent craniopharyngioma is an efficient method for tumor control and should be proposed whenever the recurrent tumor is solid. Morbidity results above all from tumor aggressiveness, rather than from surgical damage.     

Craneofaringiomas: experiencia y resultados

IntroductionCraniopharyngiomas are a big challenge in the neurosurgical field. Because these lesions involve important systems, surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. We present the outcomes of our patients based on clinical results, degree of resection, recurrence and disease-free survival.Materials and methodsWe reviewed medical records in all patients who had undergone surgical resection for craniopharyngioma at (Hospital Italiano de Buenos Aires) between 2007 and 2019. We considered ophthalmological examinations, imaging studies, endocrinological studies and surgical complications. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor location.ResultsThirty cases of craniopharyngioma were analysed. 12.5% were classified as intrasellar, 12.5% as prechiasmatic, 43.75% as retrochiasmatic, and 31.25% as intraventricular. Overall, 38 cases involved a transcranial surgery (15 orbitozygomatic approach; 19 pterional approach and 4 transcallosal approach), seven involved a transsphenoidal approach, two microscopic transnasal approach and one ventricular endoscopy for emptying the craniopharyngioma cyst. Gross-total resection was achieved in 43.7% and near-total resection (more than 90%) in 25%. The mean follow-up period after resection was 4.7 years. Tumor recurrence occurred in 48%, with an average of 42.7 disease-free months.ConclusionTotal tumor resection is the best treatment for craniopharyngioma. Due to its high morbidity and mortality, a multidisciplinary team is necessary for the management of these tumors.     

Ectopic recurrence of a craniopharyngioma in a 15-year-old girl 9 years after surgery and conventional radiotherapy: case report

This 15-year-old girl was operated due to an ectopic recurrence of a craniopharyngioma along the previous surgical route. She presented with a sellar craniopharyngioma at the age of 4 years and underwent a right subfrontal craniotomy. Two and a half years later she had a local recurrence in the sella that was resected along the same surgical route. Postoperative cranial radiotherapy was administered with 50 Gy divided into 28 fractions. Nine years later, magnetic resonance imaging (MRI) revealed a local recurrence within the sella together with a supraorbital cystic mass. Both tumors were surgically removed. Microscopic examination revealed recurrence of an adamantinous craniopharyngioma at both localisations. Histopathological preparations showed a higher MIB-1 index at the simultaneous recurrences in the sella and in the frontal lobe and also an elevated focal p53 expression, compared to previous operations, suggesting a transformation to a more aggressive tumor. This is the first case report of ectopic recurrence in a child that had received conventional radiotherapy of 50 Gy to the sella. Careful intra-operative procedure is probably crucial for preventing ectopic recurrences. The future will reveal if the transsphenoidal surgical route will put an end to ectopic tumor recurrence in patients with a craniopharyngioma.     

New radiotherapy techniques in the treatment of patients with craniopharyngioma: a report of two cases

The authors report two cases of adult patients with craniopharyngioma recurrence after surgery. In both these patients radiotherapy resulted in a complete regression of the neoplasms, confirmed both by clinical examination and MR imaging. In both cases modern radiotherapy techniques were used so as to spare healthy tissues surrounding the tumor. Case 1. A 56-year-old man was admitted with an extensive (3.5 x 4.0 x 4.0 cm) recurrent craniopharyngioma 3 years after the initial surgery and 3 months after a surgery for relapse. Conformal 3-D planned fractionated radiotherapy to the total dose of 54 Gy in 30 fractions was delivered encompassing the tumor with 5 mm margins. Four months after radiotherapy MR imaging demonstrated a complete regression of the neoplasm and the patient recovered totally from his endocrine deficiency and neurological symptoms. Case 2. A 29-year-old man was irradiated 10 months after the initial surgery when a relapse of craniopharyngioma was found in MR imaging. The largest diameter of this recurrent tumor was 18 mm. The patient was subjected to fractionated stereotactic radiotherapy to the total dose of 54 Gy in 27 fractions. Two months after the treatment his complete recovery was confirmed by MRI. Benefits resulting from the use of more recent radiotherapy techniques in the management of craniopharyngioma are discussed.     

Radical resection of craniopharyngioma

Introduction The best management of craniopharyngioma in children remains a controversial topic among neurosurgeons. The two treatments for craniopharyngioma most commonly discussed in the literature are primary total resection and limited resection followed by radiotherapy. Without ignoring the challenging behavior of these tumors, we strongly believe that the first approach in a child with a craniopharyngioma is to attempt total removal. Trying to remove a craniopharyngioma that has been treated previously with other methods is, in our experience, much more dangerous because of adherences of the tumor to vascular and neural structures.Material and methods Between 1988 and 2004, we operated on 153 patients with craniapharyngioma (40% female and 60% male), whose ages at the time of surgery ranged from 15 days to 21 years (mean 10.5 years). Eighty-seven percent of the patients were found to have some visual disturbance and 42% endocrinological alterations. Fifty-four percent of the patients presented hydrocephalus, but only 18% had shunting. Gross total removal was attempted in all patients. Among the 153 patients, the tumor was prechiasmatic in 35 and retrochiasmatic in 112; in ten, these were considered giant forms, and eight had a posterior fossa extension. We performed 84 single and 69 combined approaches.Results We achieved total removal in 69% of our patients. None of our patients regarded as having undergone total tumor resection disclosed recurrence after a follow-up of 1–16 years. Radiation therapy was administered in children with subtotal removal. All children underwent total removal, but only 62% of those who underwent subtotal removal had good outcomes. After surgery, endocrinological status worsened in almost all patients, but visual status improved markedly.Conclusions The treatment of choice in craniopharyngioma in childhood is total resection in order to avoid radiation therapy and recurrence. When total resection is not possible, subtotal resection plus radiation therapy is the alternative.