颅咽管瘤按发生位置分型和命名——附手术入路与切除方法

目的介绍按颅咽管瘤发生位置来分型方法,并探讨其临床价值。方法回顾性分析215例颅咽管瘤患者的临床资料,根据术前影像学资料、术中发现将颅咽管瘤划分为4种类型,即：Ⅰ型,鞍内颅咽管瘤;Ⅱ型,鞍上颅咽管瘤;Ⅲ型,室下颅咽管瘤;Ⅳ型,室前颅咽管瘤。结果59例Ⅰ型颅咽管瘤全部采用翼点入路切除肿瘤,全切除率为83.1%（49/59）;75例Ⅱ型颅咽管瘤中,74例采用翼点入路,1例采用翼点联合胼胝体入路,全切率为82.7%（62/75）;49例Ⅲ型颅咽管瘤,全部采用翼点入路,全切除率为93.9%（46/49）;32例Ⅳ型颅咽管瘤,全部采用胼胝体入路,全切除率为93.8%（30/32）。结论按发生位置来分型颅咽管瘤是可行的,并使其各自成为相对独立的疾病,更有利于在制定诊疗方案和疗效评价上达成共识。

Classification of craniopharyngiomas based on their sites of origin and its value in selection of surgical approaches and total resection of tumors

ObjectiveTo introduce a method for classification of craniopharyngioms based on their sites of origin and to explore its value in the selection of surgical approaches and total resection of tumors.MethodsThe clinical data of 215 patients with craniopharyngioma were analyzed retrospectively. The sites of origin of craniopharyngiomas were identified according to preoperative neuroimagings and intraoperative pathological findings, and then the craniopharyngiomas were categorized into four types： typeⅠ,intrasellar craniopharyngiomas; typeⅡ, suprasellar craniopharyngiomas; typeⅢ, hypoventricular craniopharyngiomas; typeⅣ,anteventricular craniopharyngiomas.ResultsOf 59 patients with craniopharyngiom belonged to typeⅠ, all patients received resection of tumors through pterion approach and total resection was achieved in 49 patients（83.1%）. Of 75 patients with craniopharyngiom belonged to typeⅡ, 74 patients received resection of tumors through pterion approach and 1 through pterion approach combined with trans-callosal approach, and total resection was achieved in 62 patients（82.7%）. Of 49 patients with craniopharyngiom belonged to typeⅢ, all patients received resection of tumors through pterion approach and total resection was achieved in 46 patients（93.9%）. Of 32patients with craniopharyngiom belonged to typeⅣ, all patients received resection of tumors through trans-callosal approach and total resection was achieved in 30 patients（93.8%）.ConclusionsIt is feasible to categorize craniopharyngiomas according to their sites of origin. The classification scheme is useful for the decision-making of surgical strategy of patients with craniopharyngioma.