Long-term results of treatment for craniopharyngioma in children

Results of the treatment of 27 children with craniopharyngioma are reported. A subfrontal pterional approach was used in 55.6% of cases, a transsphenoidal and a transcallosal or transcortical approach in 25.9% and 18.5% of cases, respectively. Radical removal was the goal of surgery and was achieved in 70.8% of cases treated as primary surgery. The operative mortality was 3.7% and was due to hypothalamic failure. Most (81.4%) patients were followed up, for a mean of 7 years. Patients were evaluated according to a functional evaluation scale and outcome categories proposed by us. The scale takes account of tumor (recurrences and their eventual evolution); visual functions; endocrine functions (mainly hypothalamic), attainment of endocrine balance and drug regimen; headache; and psychosocial function. Recurrences were observed in 17.6% of patients treated with radical surgery and in 42.8% of those treated with limited surgery plus radiotherapy. A progressive amelioration of visual, endocrine and neuropsychosocial functions from the intervention to follow-up was observed in the majority of patients. Complete tumor excision was associated in 85% of cases with a low score on the functional scale, reflecting a high functional performance. Adequate substitution therapy maintained endocrine balance in 81% of patients. Since the intervention a progressive decrease in the number and dosages of medications has been observed. The majority of patients were again able to lead a normal social life. Small stature, obesity, headache, and emotional and sexual disturbances were frequent cause of long-term disability even despite adequate drug regimens. The functional evaluation scale we propose is a simple and effective tool that can be easily used during routine evaluation of patients with craniopharyngioma. Received: 26 February 1997     

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。     

替尼泊甙治疗恶性脑胶质瘤的远期结果

报道替尼泊甙－ＣＣＮＵ治疗恶性脑胶质瘤９６例随诊１～１０年的远期结果．男性６６例、女性３０例．年龄５～７４岁，平均３９．７岁。治疗周期总数４４８个，平均５个／例．远期结果计：ＣＲ１８例、ＰＲ２１例，ＲＲ率４０．７％；ＳＤ１９例、ＰＤ３７例、ＥＤ１例．存活率为：１年８５％、３年２６％、５年１４．６％、１０年１％。目前仍存活之１４例中已逾５年者５例．平均有效时限为ＣＲ组２１２周、ＰＲ组１２１周、ＳＤ组４６周、ＰＤ组１２周。平均存活时限为ＣＲ组２４１周、ＰＲ组１３３周、ＳＤ组５７周、ＰＤ组１８周。     

Individualized treatment of craniopharyngioma in children: ways and means

Background Medium- and long-term prognosis of craniopharyngioma is overwhelmed by the risks of hypothalamic and visual impairment. This problem has been underestimated for a long time because the major concern for the neurosurgeon was the risk of recurrences, their best prevention being thought to be complete tumour resection. Today, we know that radical surgery not only is not an absolute guarantee against recurrences but also can cause hypothalamic and visual complications.Methods The authors suggest that instead of complete removal, the first choice treatment should be, when possible, a less aggressive, multistaged and personalized treatment. In this perspective they focus on other therapeutic methods: endocavity treatment of cysts with rhenium-186, triconformational radiotherapy, radiosurgery, and widespread use of the trans-sphenoidal approach.Conclusions These simple methods should reduce the risks of visual aggravation and metabolic syndrome.     

Long term results of lumbar sequestrectomy versus aggressive microdiscectomy

It remains unknown whether aggressive microdiscectomy (AD) provides a better outcome than simple sequestrectomy (S) with little disc disruption for the treatment of lumbar disc herniation with radiculopathy. We compared the long term results for patients with lumbar disc herniation who underwent either AD or S. The patients were split into two groups: 85 patients who underwent AD in Group A and 40 patients who underwent S in Group B. The patients were chosen from a cohort operated on by the same surgeon using either of the two techniques between 2003 and 2008. The demographic characteristics were similar. The difference in complication rates between the two groups was not statistically significant. During the first 10 days post-operatively, the Visual Analog Scale score for back pain was 4.1 in Group A and 2.1 in Group B, and the difference was statistically significant (p < 0.005). The Oswestry Disability Index score was 11% in Group A and 19% in Group B at the last examination. The reherniation rate was 1.5% in Group A and 4.1% in Group B (p < 0.005). We argue that reherniation rates are much lower over the long term when AD is used with microdiscectomy. AD increases back pain for a short time but does not change the long term quality of life. To our knowledge this is the first study with a very long term follow-up showing that reherniation is three times less likely after AD than S.     

Long term treatment of tardive dyskinesia.

A 4 year trial to treat tardive dyskinesia by a very slow progressive stepwise diminution of the neuroleptic dose and of antiparkinsonian agents as well as by administration of small, slowly increasing and then decreasing doses of reserpine or haloperidol was conducted on 62 chronic schizophrenic patients. This treatment program caused disappearance of tardive dyskinesia in 23, improvement in 26 patients and had no effect in 13 patients. The group of patients with disappearance of tardive dyskinesia had a mean age significantly lower than other groups. The rationale of this treatment was based on the concept of "desensitization" by a slow, progressive unblocking of dopaminergic receptor sites. Another tardive neuroleptic side effect, the "rabbit syndrome" was successfully treated in 7 other patients by antiparkinsonian drugs.     

Long term treatment with oxaprotiline in patients with major depression

1. 1) Four hundred thirty-seven patients with depressive illness were treated for up to 11 months with oxaprotiline (Ba-49802B)in a continuation study.

2. 2) Results of this study suggest that oxaprotiline continued to be effective in alleviating depressive symptoms.

3. 3) Additionally, evaluation of safety parameters failed to reveal any significant risk to patients who were treated with oxaprotiline over this extended period of time.

Complications in paediatric craniopharyngioma treatment

Forty-eight consecutive children treated for craniopharyngioma at the Juan P. Garrahan National Paediatric Hospital (Buenos Aires, Argentina) from 1988 to 1994 are described. Complications of patients undergoing total resection alone and those undergoing subtotal or partial resection plus radiotherapy were compared. Survival time and quality of life proved more satisfactory in the former group, as there were no recurrences. In contrast, among the latter patients, 53% suffered relapses. Endocrinological complications were similar in the two groups. Postsurgical subdural haematomas were quite frequent and eight patients required treatment for intracranial hypertension. Vascular complications, though less common, led to high morbidity and mortality. There was a considerable incidence of shunt malfunction (80%), arguing against placement of a preoperative shunt, which tended besides to foster postsurgical subdural haematomas.     

Long term group psychotherapy with (near) psychotic children

Traditionally, psychotherapy groups for children included only relatively intact youngsters. This paper describes a group consisting of four (near) psychotic children and two co-therapists which met for over three years. The developmental changes which occurred in the group over the course of time will be identified and discussed using a neo-psychoanalytic, object relations framework.     

伽玛刀治疗颅底良性脑膜瘤长期疗效分析

目的总结评价伽玛刀(γ刀)治疗颅底良性脑膜瘤的长期疗效。方法217例患者平均年龄52.2±13.8岁(9～83岁),男性65例,女性152例;病史0.5～216个月,平均35.5个月,中位时间26个月;105例曾行手术治疗;肿瘤容积0.41～42.8cm3,平均6.8±6.1cm3;均行增强MRI定位扫描;边缘剂量10～20Gy,平均13.9±1.8Gy,中心剂量22.2～40Gy,平均27.7±4.6Gy;等剂量曲线40%～60%,平均49.53%;等中心数2～20个,平均10个。结果随访36～120(平均69.8±21.8)个月,肿瘤控制率为97.7%(212/217);临床表现:130例(59.9%)好转,78例(35.9%)稳定,9例(4.1%)恶化;9例曾出现一过性症状加重;2例(0.9%)出现放射性水肿;6例(2.8%)于γ刀后行显微外科手术切除。结论伽玛刀治疗颅底脑膜瘤可长期控制肿瘤生长,并发症较少,能保证患者良好的生存质量,即为术后残留或复发的患者提供了进一步治疗的方法,也为较小颅底脑膜瘤患者治疗的主要疗法。     

Long term depression

Our practice, in a unit of treatment of dysthymic state being confronted with problems of relapses and recurrences, we have questioned the therapeutic strategies in the long run and their possible assessments. After recalling conceptual and methodological reference about relapses, recurrences and therapeutic assessment, we propose the methods and first results of a retrospective naturalistic study over a period of three years of practice in our treatment unit including 994 cases. We bring out, as soon as the first major depressive episode occurs, a strategy that aims at setting up a therapeutic proceeding tending to treat, beyond the dysthymic episode, the obsessional pre and post-morbid "locks" which seem to "make the bed" of many relapses and recurrences. In this prospect, the interest of serotoninergic molecules with double polarity, anti-depressive and anti-compulsive, is emphasized.     

Results of the management of craniopharyngioma in children

The treatment results of 21 (1972–1982) patients with craniopharyngioma are reported who were treated either by surgery alone or by surgery and radiation therapy. The authors reviewed 14 patients (67%) who were less than 18 years of age at the time of surgery. The eradication was thought to be total in 7 children and subtotal in 7. Radiation was given as part of the initial therapy to 5 children after total excision and to 3 after subtotal removal. There were 2 postoperative deaths. All of the children suffered postoperative hormonal deficiencies. The results of this study indicate that total and subtotal removal followed by RT is an acceptable treatment for craniopharyngioma. Endocrine-deficient children, if treated properly, do well in terms of survival.     

Monstrous craniopharyngioma. Case presentations and term proposal.

INTRODUCTION: Craniopharyngiomas (CF) are benign tumors, which can be cured by total resection; however, this is not always possible to achieve, thus leading to tumor recurrence. When these tumors achieve disproportionate growth, the treatment is even more difficult, fortunately grotesque CF are not frequent, making experience and data collection more arduous to obtain. CASE REPORTS: Four patients are presented here to illustrate the need for the use of a new term, "monstrous craniopharyngioma," which is proposed with the aim of making the evaluation of the different kinds of treatment available more accurate. CONCLUSIONS: Craniopharyngiomas that have grown into more than one cranial fossa with mixed solid and cystic components pose a special challenge for resection, and therefore a systematic classification and approach are required in order to obtain the best surgical results.