| Recurrent craniopharyngioma is a huge challenge for doctor, tumor recurrence after surgery is an important problem to craniopharyngioma treatment. The tumor appeared again after tumor resection called recurrent craniopharyngioma. Neurosurgeon should fully realize the importance of recurrent craniopharyngioma and complexity. Understand the cause of the recurrence of craniopharyngioma is helpful to reduce the recurrence rate, is very important for the treatment of craniopharyngioma. The following mainly analyzes the causes of recurrent craniopharyngioma. The aim of this study was to define the determinative role of age, gender, pathological type, surgical resection, tumor size, hydrocephalus and tumor growth pattern on recurrence.Chapter I. The influence factors of recurrence of craniopharyngiomaObjective:Analysis the age, gender, histological type, surgical resection, tumor size, hydrocephalus and tumor growth pattern of craniopharyngioma, explore the influencing factors of tumor recurrence.Method:From January 1997 to January 2009,177 patients with primary craniopharyngiomas underwent surgery in our department by the senior author. Age, sex, pathology, extent of resection, size, hydrocephalus, growth pattern were analyzed. The statistical software package SPSS 17.0 was used for statistical analysis. Predictors using Logistic regression analysis, differences between all different groups using X2 test. The P value for significance was set at 0.05.Results:Logistic regression analysis of the patients of this series showed that age, extent of resection, and growth pattern were independent covariates that significantly affected outcomes after repeated surgery (P<0.05). The different of recurrent rate between group Q, S and T was statistically significant (P<0.05). The recurrent rate of Q type was 27.9%, recurrent rate of the S type was 6.5%, recurrent rate of T type was 14.6%. The difference between total resection group and subtotal resection group was significant (P<0.05). Of which total resection group recurrent rate was 10.1%, and recurrent rate of subtotal resection group was 38.5%. The difference between children and adults was statistically significant (P<0.05). The recurrence rate of children was 25.0%, the recurrence rate of adults was 11.0%. There was no significant difference between less than 6 cm group and large than 6 cm group (P>0.05). The recurrence rate of less than 6 cm group was 27.3%, the recurrence rate of large than 6 cm group was 15.7%. There was no significant difference between squamous papillary tumor group and ameloblastoma tumor group (P>0.05). The recurrence rate of squamous papillary tumor group was 16.7%, the recurrence rate of ameloblastoma tumor group was 14.3%.Conclusion:Totally resection was a factor that affect whether the tumor recurrence. Clear understanding of tumor growth pattern and arachnoid membrane structure can help to choose a best surgical approach and.Chapter â…¡. Clinical characteristics and operative treatment of recurrent craniopharyngiomObjective:Explore the clinical characteristics of recurrent craniopharyngioma.Method:From January 1997 to January 2009,52 cases of recurrent Craniopharyngioma accepted the second surgery in our department.18 patients had recurrences after primary surgery performed between 1997 and 2009 in our department.34 patients were primarily operated on elsewhere. Preoperative and postoperative clinical manifestations and MRI were collected. The difference between the primary tumor and recurrent tumor was compared. SPSS statistical software package 17.0 was used for statistical analysis. Chi-square test was used to compare the different of imaging data, clinical manifestation.t test was used to compare the tumor size. The P value for significance was set at 0.05.Results:Re-recurrence rate was 17.30% in this study. There were statistically difference in headaches, reduced vision and blindness, increased appetite, obesity, disturbance of consciousness between first surgery group and second surgery group (P<0.05). Blindness and growth retard rate was significantly higher in Q type group than TS type group. Memory disorders rate was significantly higher in TS type than Q type (P<0.05). The nausea, vomiting, weight loss rate is significantly higher in child group than adult group (P<0.05). There was significant differences between different treatment group in recurrent-free survival of primary tumor (P< 0.05).Totally resecution group and radiotherapy group have a longer recurrent-free survival.Conclusion:There were statistically difference in symptoms, selection of surgical approach and hypothalamic-pituitary functions between primary craniopharyngioma and recurrent craniopharyngioma. Preoperative vision loss and obesity in patients with recurrent craniopharyngioma happens more than primary craniopharyngioma. Origin of craniopharyngioma has a direct influence on the growth pattern of recurrent craniopharyngioma. Growth pattern significantly affected the symptoms, signs of patients undergoing repeated surgery.Chapter â…¢. The operation treatment of recurrent craniopharyngiomaObjective:Study the operation characteristics of recurrent craniopharyngioma.Method:From January 1997 to January 2009,52 cases of recurrent craniopharyngioma accepted the second surgery in our department. We retrospective study the operation of recurrent craniopharyngioma.Results:52 patients with craniopharyngioma initial surgical approach: transsphenoidal (2 cases,3.85%), trans-lamina terminalis approach (2 cases,3.85%), pterional approach (40 cases,76.92%), transcallosal approach (5 cases,9.61%), the lateral ventricle approach (3 cases,5.77%). Second surgical approach: transsphenoidal (1 case,1.92%), trans-lamina terminalis approach (20 cases,38.46%), frontotemporal approach (29 cases,55.77%), subfrontal approach (1 case,1.92%), the lateral ventricle approach (1 case,1.92%).Conclusion:The total removal of recurrent craniopharyngioma is still difficult, because arachnoid damaged in first surgery may, radiotherapy and the insertion of Ommaya capsule. Surgery is still the best way to cure recurrent craniopharyngioma, if the tumor recurrence for many times, reoperation can treat this problem. Neurosurgeons should clear understood the origin of the tumor, the growth pattern and the surrounding arachnoid membrane structure in the treatment of recurrent craniopharyngioma, which performed correctly identify to choose the best surgical approach.Chapter IV. The prognostic characteristics of recurrent craniopharyngiomaObjective:Through the retrospectively analyzed in the hypothalamus-pituitary function, outcome of recurrent craniopharyngioma.Methods:From January 1997 to January 2009,52 cases of recurrent Craniopharyngioma accepted the second surgery in our department..Clinical manifestations, endocrine function, the function of the hypothalamus and MRI were analysis. All cases according to the treatment before recurrence were divided into four groups:The patients were divided into the following previous treatment groups: radical tumor resection (group A; n=13), incomplete tumor resection (group B; n= 11), radiotherapy followed by incomplete tumor resection (group C; n=7), Ommaya reservoir placement followed by incomplete tumor resection (group D; n=4). SPSS statistical software package 17.0 was used for statistical analysis. Logistic regression analysis was used to analysis the factors that affected outcome. Survival and the recurrence-free curves were generated using the Kaplan-Meier method, and differences between recurrence-free survival curves were evaluated using the log-rank test. The P value for significance was set at 0.05.Results:According to Logistic regression analysis (forward-LR), preoperative radiotherapy and the growth of craniopharyngioma is risk factors affecting the prognosis (P<0.05). While age, sex, tumor size, histological type, Ommaya placement was not risk factor affecting the prognosis (P>0.05). ACTH, TSH and LH/FSH lack rate in Q type is higher than TS type (P<0.05). The patient of radiotherapy group had a poor outcome and pituitary function.Conclusion:Previous treatments play an important role in repeated surgery of patients with recurrent craniopharyngiomas. Radiotherapy before repeated surgery can result to a worse functional outcome and hypothalamic-pituitary function. Origin of primary craniopharyngiomas was significantly affected outcome of recurrent craniopharyngiomas. Patients with type TS recurrent tumors had significantly worse functional outcome compared with the type I recurrent tumors, but this type of tumors had a better pituitary function. |
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