Analysis For 92 Cases Of Craniopharyngioma Treated By Microsurgery

Objective:To summarizes the clinical characteristics,imaging characteristics,diagnosis and treatment process,postoperative complications and follow-up of the patients with craniopharyngioma admitted to the First Affiliated Hospital of Guangxi Medical University in the past six years,and analyzes the relationship between different surgical approaches,tumor sizes and postoperative complications on the surgical treatment effect.Methods:In 134 cases of craniopharyngioma diagnosed in the First Affiliated Hospital of Guangxi Medical University from June 2012 to January2019 were collected by retrospective analysis.According to the inclusion and exclusion criteria,92 effective cases were obtained.According to the surgical approach,they were divided into four groups(pterygoid group,subfrontal group,longitudinal fissure(transcallosal)group,longitudinal fissure(endplate)group)and Zhu Xianli et al Tumor types were divided into four groups(intrasellar type group,suprasellar type group,subventricular type group,preventricular type group);according to the largest diameter of tumor,three groups(<2.5cm group,2.5cm-4.5cm group,>4.5cm group).The course,clinical manifestation,laboratory examination(mainly routine biochemical examination and pituitary hormone level),imaging data,surgical approach and surgical resection,postoperative complications and follow-up results were statistically analyzed;the resection rate and complication rate of each group were analyzed.The data were processed by spss25.0,and X~2test and Fisher exact probability method were used to analyze the difference of composition ratio of each group.Results:(1)92 cases were divided according to the operative approach:61 cases were via pterional approach,including 32 cases of total resection(52.5%),17 cases of subtotal resection(27.9%),12 cases of partial resection(19.7%);17 cases of subfrontal approach,including 8 cases of total resection(47.1%),6 cases of subtotal resection(35.3%),3 cases of partial resection(17.6%);8 cases of transcallosal approach,including 3 cases of total resection(37.5%),1 case of subtotal resection(12.5%)Among them,total resection in 2 cases(33.3%),subtotal resection in 0 cases(0.0%),partial resection in 4 cases(66.7%).X~2test results:X~2=10.665,P=0.141.It shows that there is no significant difference between different surgical approaches and resection rates.(2)92 cases were divided into two groups according to the maximum tumor diameter:29 cases in<2.5cm group,including 26 cases of total resection(89.7%),2 cases of subtotal resection(6.9%),1 case of partial resection(3.4%);46 cases in 2.5cm-4.5cm group,including 18 cases of total resection(39.1%),20cases of subtotal resection(43.5%),8 cases of partial resection(17.4%);17cases in>4.5cm group,including 1 case of total resection(5.9%),2 cases of subtotal resection(11.8%))Results:X~2=56.762,P=0.000.The results showed that there were significant differences in the maximum diameter and resection rate of different tumors.(3)92 cases were divided into two groups according to the location of tumor:21 cases of intrasellar type,including 21 cases of total resection(100.0%),0cases of subtotal resection(0.0%),0 cases of partial resection(0.0%);37 cases of suprasellar type,including 11 cases of total resection(29.7%),17 cases of subtotal resection(45.9%),9 cases of partial resection(24.3%);24 cases of subventricular type,including 10 cases of total resection(41.7%),6 cases of subtotal resection(25.0%),and 6 cases of partial resection In addition to 8 cases(33.3%);10 cases of pre ventricular type,including 3 cases of total resection(30.0%),1 case of subtotal resection(10.0%),6 cases of partial resection(60.0%);X~2test results:X~2=37.876,P=0.000.It shows that there are significant differences in tumor types and resection rates.(4)Among the 92 cases,55(59.8%)had postoperative complications,including4(4.3%)with postoperative cerebral hemorrhage,39(42.4%)with non central infection,8(8.7%)with central infection,17(18.5%)with central hyperthermia,42(45.7%)with sodium metabolism disorder,34(37.0%)with diabetes insipidus,and 31(33.7%)with hormone abnormality.X~2test was carried out for different surgical approach groups and tumor maximum diameter groups and each complication respectively(P>0.05).The results showed that there was no significant difference in the incidence of complications between different surgical approaches and different tumor maximums.Conclusions:1.There was no significant difference in surgical resection rate between different surgical approaches.2.Different tumor maximum diameter has a significant effect on the total resection rate.The larger the tumor diameter is,the more difficult it is to complete resection.3.Different types of tumor location have a significant impact on the resection rate.The resection rate of intrasellar craniopharyngioma is higher than that of other three types of craniopharyngioma.4.There was no significant difference in the incidence of postoperative complications between different surgical approaches and tumor sizes.5.Craniopharyngioma is difficult to be operated on.It is adjacent to the important structure of the brain and easy to damage the hypothalamus pituitary structure during the operation.The main postoperative complications were infection(central and non central),diabetes insipidus,decreased hormone level and disorganization of sodium metabolism.6.Microsurgery is still an effective method for the treatment of craniopharyngioma.Preoperative evaluation,tumor location,choice of surgical approach and experience of the operator determine the quality of the operation.