Reaserch About Expended Endoscopic Endonasal Transsphenoidal Approach Resection Of Craniopharyngiomas And Comparation With Open Transcranial Approach Surgery Outcome

Objective:Based on 64 cases of craniopharyngioma(CP) Patients clinical data retrospective analysis,which within the regional context of midline skull base and underwent Expended endoscopic endonassal transsphenoidal surgery(EETA,N=36) and Open transcranial surgery(OTCA,N=28),to compare the feasibility,safety,as well as the advantages and disadvantages of those two approachs.Contrast long-term follow-up prognosis between the two series.In order to provide a reference for the choice of surgical approach.Comprehensively analyse the imaging, surgery video,intraoperative conditions, postoperative recovery data of the cases that were applied EETA surgery.Get craniopharyngioma skull ventral anatomy characteristic data,and value cerebrospinal fluid leakage(CSF) associated risk factors,to provide references about surgical experience, preoperative prediction, reducing complications.Methods:Retrospectively analyse the imaging, surgery video, intraoperative conditions,postoperative recovery data and follow-up prognosis of 64 cases collected from January 2010 to December 2014,operated craniopharyngioma resection.Divided into two groups according to the surgical approach:Expended endoscopic endonassal transsphenoidal approach(EETA, N=36) group and Open transcranial approach(OTCA,N=36) group.The latter series include the patient transpterional approach,subfrontal approach,transcallosum approach, trans-laminal terminal approach,but exclude non midline tumor types.The comparation study take operating time,anatomic parameter measurements, surgical conditon,tumer resection time,intraoperative bleeding volume,the simplify NIHSS score six hours after operation,postoperative hospital stay,total resection and subtotal rate,intraoperative and postoperative complications,long-term follow-up assessment of quality of life and other relevant circumstances into consideration 。 At laster,analyse associated risk factors for postoperative cerebrospinal fluid leakage after EETA surgical procedures.Results:1.Operating time,tumer resection time,intraoperative bleeding volume of EETA and OTCA group was 121.8±17.00 min VS 184.1±11.32 min 、 29.2±6.84 min VS47.5±7.56 min 、 72.5±13.81 ml VS 169.3±41.72 ml respectively, the statistical differences were significant(P<0.001).Simplify NIHSS score 6 hours after operation was 2.36±2.59 VS 4.96±3.64, P=0.002, significantly different. 6 month Follow-up quality of life scores was 18.7±15.98 VS 34.5±22.79, P=0.003, significantly different.2. GTR of EETA group and OTCA group were 83.3% and 78.6% respectively, P= 0.163, the difference was not significant.Intraoperative vascular injury event, optic nerve damage event, parenchymal injury event rate of each group were 2.8%VS10.1%, 2.8% VS10.1%, 0% VS7.1%, P>0.05, the difference was not significantly.Postoperative complications like decreased visual and field, transient diabetes insipidus increase, transient electrolytic disorders, headache aggravated, fever,transient pituitary function decline rate of the two groups were 11.1% VS17.9%, 50%VS39.3%, 58.3 % VS71.4%, 19.4% VS28.6%, 13.9% VS21.4%, 13.9% VS21.4%,30.6% VS17.9% respectively, the P values were greater than 0.05, the difference was not significantly. The pituitary stalk,which could be found,protection rate was70.8% and 38.9% respectively for each groups,P = 0.038, significantly different.3. Anatomic parameter measurement:66.7% sphenoid separate point internal carotid artery prominence;Bilateral m OCR visible rate was 82%, average spacing11.1±0.9mm;Bilateral optic prominence visible rate was 85%, average inside pitch was 10.2±0.7mm;Bilateral internal carotid artery prominence visible rate was 72%,average spacing of its inside edge was 11.8±0.9mm; bilateral cavernous inner distance was 11.6±1.1 mm;Pituitary-opticchiasm gap 10.4±2.1mm.4. CSF leakage risk factors:21 cases of tuberculum meningiomas and 45 cases of huge hypophysomas,which growth up out of diaphragma and the arachnoid was broken intraoperation,were tanken into investigation to constitute a total sample contains 102 cases.Undergo Logistic regression analysis, obtain the risk factors formula: Log [P /(1-P)] =- 12.696 + 0.886×(third ventricle openness degree) +1.787×(saddle compartment leak flow rate) + 1.423×(unused balloon) +1.311×(incomplete vascularized nasoseptal flap).Conclusions:1.Craniopharyngiomas undergo EETA could achieve the same results as OTCA.Furthmore,in certain aspects like operating time,tumer resection time,intraoperative bleeding volume as well as postoperative response and recovery for EETA has an advantage over OTCA.2. Although there was no significant difference between EETA and OTCA in the rate of GTR, intraoperative complications and postoperative complications,the pituitary stalk protection rate of EETA takes advantage.3. Sphenoid multiple septum topography,directions the septums pointed may denote the location of the internal carotid artery;The anatomical location of m OCR were relatively constant, so,it is an important anatomical reference point, the average pitch was 11.1±0.9mm, its center is located slightly inside of the outer edge of the cavernous sinus;Average pituitary-opticchiasm gap was 10.4 ± 2.1mm.4. EETA postoperative CSF leakage risk factors: third ventricle openness degree,saddle compartment leak flow rate,unused balloon,incomplete vascularized nasoseptal flap.