Factors Influencing The Effect Of Microsurgical Surgery On Craniopharyngioma (71 Cases)

Objective: To investigate the microsurgical approach of craniopharyngioma and the surgical outcome.Methods: A retrospective analysis of 71 patients with craniopharyngioma who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2014 to August 2018 for microsurgery.The degree of tumor resection and recurrence in the two main surgical approach(pterion approach and frontobasal interhemispheric approach)were compared to study the influence of surgical approach on the treatment effect.According to the preservation of pituitary stalk during operation,it was divided into two groups.Hormone level changes before and after operation were analyzed to study on the influence of pituitary stalk preservation on microsurgical effect in endocrine dysfunction.According to the calcification of the tumor,the size and the involvement of the three ventricles,it was divided into three groups.The preservation of pituitary stalk in each group was analyzed to study the influencing factors of pituitary stalk preservation.Results: The total removal rate of the two main approach was 65% and 71.4% respectively while the recurrence rate was 20% and 35.7%.The difference between the two groups was not statistically significant(both P >0.05).43.5% of the patients with pituitary stalk preservation had new endocrine dysfunction or the dysfunction was worse than that before operation,which was significantly lower than those with the pituitary stalk resection(80%).The difference was statistically significant(P <0.05).The retention rate of pituitary stalk in patients with tumor calcification was 45.9%,which was lower than that in non-calcified patients(85.3%).The difference was statistically significant(P<0.05).Conclusion: 1.An appropriate surgical approach based on the characteristics of the tumor is of great significance for improving the gross total resection rate of the craniopharyngioma and reducing the recurrence rate.2.Preserving the pituitary stalk as much as possible can reduce the endocrine function damage,which is of positive significance for improving the curative effect of craniopharyngioma.3.The retention rate of pituitary stalk in patients with craniopharyngioma is related to tumor calcification.The retention rate of pituitary stalk in patients with tumor calcification is lower than that without calcification.