儿童颅咽管瘤的显微手术治疗

目的探讨显微手术治疗儿童颅咽管瘤的效果。方法回顾性分析2006年1月至2011年12月手术治疗的112例儿童颅咽管瘤患者的临床资料。结果Hoffman 1~5级切除分别是86、17、5、2、2例。术后2周内死亡2例（1.8%）。术后发生多饮、多尿78例、电解质紊乱73例、一过性视力障碍10例、激素水平低下57例、下丘脑损害症状9例、缄默10例、癫痫7例。肿瘤未全切者术后辅以放疗。术后共随访到102例,随访时间20~96月,平均58个月,随访结束时96例存活,永久性尿崩症11例（9.8%）,肿瘤复发22例（19.6%）。术后生长激素水平低下者予以替代治疗,治疗者较未治疗者身高平均增加4.3 cm。结论采取个体化设计手术入路、严格脑保护、显微镜直视并辅以神经内镜操作能够提高儿童颅咽管瘤全切率并减少并发症;未全切者辅以放疗能降低肿瘤复发率;替代治疗可以取得一定疗效。

Clinical effectiveness of microsurgery for pediatric craniopharyngiomas

ObjectiveTo investigate the clinical effectiveness of microsurgery for pediatric craniopharyngiomas.MethodsOne hundred and twelve consecutive pediatric patients with craniopharyngioma received microsurgery, of whom, 29 via subfrontal approach,43 via subfrontal pterional approach, 8 via frontal interhemispheric approach, 21 via transcallosal-septum pellucidum-interforniceal approach, 4 via transsphenoidal approach and 7 via other approaches, from January 2006 to December 2011 in our hospital. The patients with residual tumor received radiotherapy after operation.ResultsAccording to the Hoffman＇s grade of the tumor resection, grade 1, 2, 3,4 and 5 was achieved in 86, 17, 5, 2 and 2 patients, respectively. The pituitary stalk was reserved in 95 patients, partially resected in 11and completely resected in 6. The symptoms were improved in 97 patients and worsened in 15 after operation. Diabetes insipidus,electrolyte disturbances, transient decline in visual acuity, transient mutism, symptoms of hypothalamic injury and epilepsy occurred in78, 73, 10, 10, 9 and 7 patients after operation, respectively. One hundred and two patients, of whom, 80, 15, 7, 7 and 7 patients were belonged to grade 1, 2, 3, 4 and 5, respectively, were followed up for 58 months（range, 20~90 months）. Seven patients recurred in grade1, 6 recurred in grade 2, and all patients recurred in grade 3~5. The patients with growth hormone replacement was taller than those without by an average of 4.3 cm. Ninety-six patients（94.1%, 96/102） survived more than 4.5 years and 3（2.9%, 3/102） died within 1year.ConclusionsThe microsurgery should be performed through individualized surgical approach in pediatric patients with craniopharyngioma and the neuroendoscopic assistance can increase the rate of total resection and decrease the rate of postoperative complication. Postoperative radiotherapy for patient with residual tumor can reduce recurrence. Hormone replacement therapy can improve the patients＇ quality of life.