颅咽管瘤术后并发症临床分析

目的：探讨颅咽管瘤术后并发症的临床特点及发生机制。方法回顾性分析73例行显微外科治疗颅咽管瘤病人术后并发症的临床特点,并探讨其发生机制。结果颅咽管瘤术后并发症复杂。下丘脑损害发生率72.6％,垂体功能低下发生率52.1％,无菌性脑膜炎发生率23.3％,视力视野障碍发生率16.4％,其他并发症包括癫痫、脑脊液鼻漏等。结论颅咽管瘤术后并发症发生率高,临床表现多样化,发生机制复杂。     

颅咽管瘤疗效与治疗方案选择

目的分析颅咽管瘤治疗效果，并探讨治疗方案与疗效的关系。方法华西医院神经外科从1997年1月至2004年2月间治疗184例颅咽管瘤患者，分单纯手术切除、手术＋放射外科治疗、非手术治疗三组，分析三组治疗效果和随访情况。结果各治疗方案具有相应的并发症、死亡率、致残率和复发率。并发症以下丘脑损害后症状复杂，发生率63.59％；垂体功能低下发生率53.26％；术后视力减弱或视野缺损加重的有11.41％，其他还有无菌性脑膜炎、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4．36年，16例失访，总体死亡率13．04％。三组治疗效果具有差异，以一次性手术全切除最佳，手术不完全切除结合放疗次之，非手术组疗效最差。总体复发率23、91％，非手术治疗组复发率最高，达33．85％（22／65），手术切除组最低，为16．22％（12／74）。结论三种治疗方案远期效果以手术切除组效果最佳。颅咽管瘤是富于挑战性的手术，并发症发生率高，易复发，必要时可结合多种治疗手段以提高疗效，     

CT立体定向囊腔内放疗治疗囊性颅咽管瘤

目的：研究治疗囊性颅咽管瘤最佳治疗方法。方法：对３４例囊性颅咽管瘤进行ＣＴ立体定向囊腔内胶体磷酸铬内放疗。结果：全部病例经手术排除囊液后临床症状迅速改善，经囊腔内放疗后１２～６６个月随访，ＣＴ扫描显示２８例（８２．５％）瘤腔持续消失，３例（８．８％）瘤腔显著缩小，症状持续改善。３例（８．８％）分别于１９、２５、３６个月后因瘤实质部分增大，症状恶化而相继死亡。无手术死亡率和严重并发症。结论：ＣＴ立体定向囊腔内放疗治疗囊性颅咽管瘤十分安全、有效，应作为治疗囊性颅咽管瘤首选的方法。     

儿童颅咽管瘤手术治疗和长期随访

目的探求在保护下丘脑功能的条件下，安全地伞切或近全切儿童颅咽管瘤。并长期随访术后病儿的生存情况。方法手术切除儿童颅咽管瘤202例。采用经胼胝体一透明隔间隙一穹隆问入路、经额部纵裂入路等八种入路切除鞍区和第三脑室内的颅咽管瘤。术前和术后采取积极措施预防和治疗下丘脑功能紊乱。并对其中的105例进行了12个月到6年的长期随访。结果全切＋近全切184例（91．1％），死亡2例（0．9％）。术后主要并发症为：尿崩症发生率80．7％，长期尿崩症率11．4％；血电解质紊乱74．8％；癫痫9．4％。术后第1年和第4年是死亡高峰。手术后5年生存率68．2％。结论选择合适的手术入路在直视下尽可能全切除颅咽管瘤，并保护第三脑室前下外侧壁（下丘脑）。术后积极防治血钠紊乱和癫痫是确保手术安全的重要措施。术后放疗可明显降低颅咽管瘤的复发率。     

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。     

第三脑室颅咽管瘤的手术治疗

目的探索手术切除第三脑室颅咽管瘤的适应证、方法、并发症预防及预后。方法对我科2000年1月至2004年4月期间收治并采取经皮质-侧脑室入路切除的38例第三脑室颅咽管瘤，结合患者术前症状和体征、影像学特点、手术效果、随访情况等进行回顾性分析。结果38例颅咽管瘤采用经皮质-侧脑室入路切除肿瘤，其中3例联合翼点入路，手术死亡率为0，达到术中全切的为28例（73．7％）。术后癫痫发作和术区硬脑膜下积液分别为2例（5．3％）和4例（10．5％），患者术后综合效果良好。平均随访26．3个月，7例（18．9％）患者复发。结论经侧脑室入路能安全切除部分第三脑室颅咽管瘤，死亡率、致残率低，术后无严重并发症，手术效果好。     

颅咽管瘤术后并发症的预防及处理（附72例报告）

目的探讨颅咽管瘤切除术后的并发症及其防治措施。方法回顾性分析我科从2004年1月至2009年6月收治的颅咽管瘤患者72例。结果肿瘤全切除38例,次全切除34例。并发症大致可分为尿崩症和水、电解质代谢紊乱、体温调节异常、癫痫发作、上消化道出血、意识障碍、无菌性脑膜炎、脑脊液鼻漏及其它,给予对症或再次手术,治愈及好转出院66例,死亡6例。随访1～60月,随访期中死亡4例,长期尿崩3例,需激素替代治疗12例。结论颅咽管瘤切除术是富于挑战性的手术,并发症发生率高,术后及时发现和处理并发症有助于患者顺利康复。     

循证护理在预防颅咽管瘤术后并发症中的应用

目的探讨循证护理模式在预防颅咽管瘤术后并发症中的作用。方法对2006-01~2008-02在本院行手术治疗的21例颅咽管瘤患者应用循证护理模式进行护理。结果21例颅咽管瘤患者术后并发症发生率低,均得到良好控制。结论循证护理对预防颅咽管瘤术后并发症具有重要作用。     

颅咽管瘤的伽玛刀治疗

目的 探讨伽玛刀治疗颅咽管瘤的疗效、适应证及并发症。方法 自1993年11月至2000年12月,使用伽玛刀治疗实体颅咽管瘤86例。其中50例行立体定向穿刺囊性部分,44例进行同位素~(32)P内放疗。治疗病灶体积0.7～26.9cm~3,平均5.37cm~3。中心剂量19.6～30Gy,平均24.6Gy。边缘剂量9.8～14Gy,平均12.4Gy。视神经和视束受照剂量小于10Gy。采用45％～55％等剂量曲线。结果 79例获随访,随访10～88个月,平均随访47个月。实体肿瘤部分控制率为88.6％(70/79),囊性部分控制有效率79.3％(50/63)。结论 手术切除仍是颅咽管瘤的首选治疗方法。伽玛刀治疗实质性颅咽管瘤,安全且有效,是手术切除后肿瘤残留复发和颅咽管瘤囊腔内同位素内放疗后等治疗手段的重要补充。对于不愿接受手术或不能耐受手术切除的患者,伽玛刀治疗也是有效的治疗选择。     

立体定向内放疗联合γ-刀治疗复发性颅咽管瘤

目的评价立体定向穿刺引流加内放疗结合γ-刀治疗复发性颅咽管瘤的有效性和安全性。方法回顾性分析26例手术后复发性囊实性颅咽管瘤的治疗经验。对16例肿瘤实体部分靠近视神经、视交又及视束者，先行立体定向穿刺抽吸加核素内放疗，再行γ-刀治疗；对10例肿瘤囊性部分靠近视神经、视交又及视束者，先行γ-刀治疗，再行穿刺抽吸加核素内放疗。结果随访6～42个月，平均24．5个月；临床症状和体征消失10例，改善13例，无变化2例，加重1例。影像学检查结果显示病变消失4例，缩小17例，无变化3例。增大2例；有效控制率为92．3％。结论对复发性囊实性颅咽管瘤联合应用立体定向穿刺抽吸引流、^32P内放疗及γ-刀等治疗手段，具有并发症少，复发率及病死率低等优点。     

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.     

Craniopharyngioma: surgical experience of 309 cases in China

OBJECTIVE: The objective of the present study was to retrospectively review the surgical outcome of 309 craniopharyngioma cases treated by a single neurosurgeon in China. PATIENTS AND METHODS: A total of 309 cases of craniopharyngioma that were treated surgically from January 1996 to May 2006. Among them, 162 (52.4%) patients were male and 147 (47.6%) were female. There were 259 (83.8%) patients older than 15 years (mean 35.8 years) and 50 (16.2%) younger than 15 years (mean 8.8 years). The tumor size varied in diameter from 2.0 cm to 9.0 cm (mean 34.5 mm). Pterional approach was performed in 211 (68.3%) cases, trans-laminal terminal approach through frontobasal interhemispheric fissure in 55 (17.8%) cases, subfrontal approach in 20 (6.5%) cases, and transcallosum approach into the anterior third ventricle in 11 (3.6%) cases. RESULTS: Total, subtotal, and partial removal of tumors were achieved in 276 (89.3%), 20 (6.5%), and 13 (4.2%) patients, respectively. The pituitary stalk was preserved in 186 (60.2%) cases, severed in 49 (15.9%) cases, and unidentified in 74 (23.9%) cases during surgery. There were 12 (3.9%) patients died within 1 month after surgery. A total of 204 (66%) patients were followed from 6 months to 8 years (mean 2.1 years). In the 167 patients with total tumor removal, 23 (13.7%) had tumor recurrence within an average of 1.8 years. While, in the 32 patients with subtotal or partial resection, 24 (75%) had recurrence within an average of 0.5 years. There were five deaths occurred during follow-up. CONCLUSION: Pre-surgery neuroimaging evaluations have improved our knowledge of intricate anatomical relationship between craniopharyngioma and the structures of the hypothalamus, pituitary stalk, and optic apparatus, which make total tumor resection feasible with the preservation of these vital structures to ensure a lower recurrence rate with acceptable mortality. However, excessive long-term morbidity, mostly related to hypopituitarism, which leads to the poor quality of life for the craniopharyngioma patients, is still remained. Further effort should be invested to monitor and maintain the normal hormone levels, hence improve the quality of life for craniopharyngioma patients.     

The therapeutic efficacy of fractionated radiotherapy and gamma-knife radiosurgery for craniopharyngiomas

There is no consensus regarding the optimal timing of radiation treatment (RT) for residual or recurrent craniopharyngioma or the preferred treatment modality between fractionated radiotherapy (FRT) and gamma-knife radiosurgery (GKRS) in terms of morbidity and efficacy. This study aims to clarify the optimal timing of RT for residual or recurrent tumors by analyzing the outcomes of RT as a salvage or adjunctive treatment, and to compare the therapeutic efficacy of FRT and GKRS. Between April 1995 and November 2009, 50 of 129 patients received RT for recurrent or residual tumors. The patients were analyzed for medical data, endocrine outcome, long-term morbidity and mortality rates, recurrence rates, and responses to adjuvant RT and GKRS. Mean progression-free survival was 92.5 months (95% confidence interval, 70.9-114.1 months). Univariate analysis revealed that pre-irradiation tumor volume was closely related to better prognosis (p=0.01). We found that there was no significant difference in recurrence between patients treated with adjuvant compared to salvage RT (p>0.05). Although we found no difference in the efficacy of FRT and GKRS, five patients were newly diagnosed with hypopituitarism following RT. We concluded that RT has a very high rate of tumor control after both adjuvant or salvage RT. This study highlights the relative safety and efficacy of FRT and GKRS.     

Craniopharyngiomas in children: surgical experience at Children’s Memorial Hospital

Objectives Craniopharyngioma during childhood poses difficulty in management because of the high incidence of surgical complications and treatment failure. In order to identify less detrimental and more effective treatment, a personal series of craniopharyngioma was reviewed in regard to various clinical factors, patient factors (age and sex), tumor factors (location and extension, relationship with chiasm, and hydrocephalus), and therapeutic modes [extent of resection and radiation therapy (RT)].Materials and methods Fifty-four childhood craniopharyngiomas treated from 1984 to 2003 were reviewed. Preoperative neuroimaging studies were classified depending upon tumor location and extension. In this series of 54 patients, 43 had total tumor resection and 11 had subtotal resection. Of the total resection group, ten showed evidence of residual tumor on postoperative neuroimaging studies. Following the initial resection, 46 did not have RT whereas 8 with subtotal resection received RT.Results There were no surgical deaths. Postoperative complications included pseudoaneurysm in 1, hemiparesis in 3, severe obesity in 5, panhypopituitarism in 50, and worsening of visual function in 7. During follow-up ranging from 12 months to 21 years, 24 patients had recurrence. Of the 33 patients with radiographic total resection, 9 (27.3%) had recurrence. Among the patients with total resection but radiographic residual and those with subtotal resection, the craniopharyngioma recurred in 90% and 100%, respectively. Three (37.5%) of eight patients with subtotal resection with RT had recurrence. Overall recurrence-free survival was 62% at 5 years and 49% at 10 years. The sex and age, location and extension of the tumor, nature of the optic chiasm, and hydrocephalus did not influence survival with statistical significance. However, the extent of surgical resection and use of RT showed significant differences for survival. Patients with total resection had a recurrence-free survival rate of 83% and 70% at 5 and 10 years, respectively. Patients with subtotal resection with RT had 71% at 5 years and 36% at 10 years. Patients who had subtotal resection or radiographically residual tumor without RT had a recurrence-free survival rate of only 9%. Among 22 patients whose recurrent tumor was treated with RT, a second recurrence-free survival rate was 90% at 5 years.Conclusion Total resection provided the best outcome. However, recurrence rates and surgical complications remained high following radical tumor resection. RT was effective for recurrent tumors and should be considered being the primary treatment for recurrences or difficult tumors, which are not amenable to total resections.     

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.     

Comparison of percutaneous trigeminal ganglion compression and microvascular decompression for the management of trigeminal neuralgia

This investigation evaluates the results of percutaneous trigeminal ganglion compression (PTGC) and compares them those for microvascular decompression (MVD) in treating trigeminal neuralgia. The authors report 127 cases of trigeminal neuralgia treated by PTGC and comparing the results with those of 114 patients whom underwent MVD from 1985 to 2000. The following parameters were compared: technical success, pain relief and recurrence, complications, perioperative morbidity, and perioperative mortality. PTGC and MVD initially had similar initial success rates. However, MVD had a higher rate of pain recurrence at the first 2 years follow-up, as well as higher rates of major complications and perioperative morbidity. Meanwhile, PTGC had higher rates of facial numbness, dysesthesia and minor complications.     

Craniopharyngiomas

A review has been carried out of those patients with a craniopharyngioma who were treated initially in our institution and had a microsurgical excision of their tumour during the period of time when newer and sophisticated modalities of investigation and treatment were available. Twenty-nine patients with craniopharyngioma were treated initially by microsurgical excision of their tumour at the Hospital for Sick Children from January 1976 to June 1985. In 21 a total removal of the tumour was performed, and there has been no clinical evidence of recurrence. No deaths were recorded in any of the 29 patients. The principal morbidity has resulted from endocrine deficits that these patients exhibit.     

Craniopharyngiomas in children: Turkey experience

Objectives Craniopharyngiomas are the most frequently encountered suprasellar tumors in children. Although they have a benign histology, total resection without morbidity is very difficult.Methods We aimed to review the results of pediatric craniopharyngioma patients treated in eight institutions in Turkey. There were 51 boys and 36 girls, ranging in age from 20 months to 18 years (mean 10.2 years). The most frequent symptom was headache, followed by visual disturbances. Hydrocephalus was seen most frequently in tumors greater than 4 cm in size (P=0.002). Hydrocephalus was associated with the decreased gross total resection (P=0.043). The recurrence (28%) was significantly higher in patients with subtotal and partial tumor removal (P=0.010). Bad outcome was significantly associated with tumor dimension (P=0.039); the greater the tumor dimension, the worse the outcome. Outcome was significantly better in patients older than 10 years (P=0.032). Gender, tumor type and location, presence of hydrocephalus and calcification, histological type of craniopharyngioma, and surgical approach did not have a significant effect on the outcome.Conclusions The treatment should be individualized and a multidisciplinary approach should be used. The goal of surgery should be gross total removal without mortality and with acceptable morbidity.