| Objective: To investigate the features of different surgical methods for craniopharyngioma,the effect of recurrence factors on total resection rate and the best management for craniopharyngioma.Methods: 144 patients were collected in our study,2016.01.01-2020.12.31.These patients were diagnosed with craniopharyngioma before operation They then underwent surgery in our hospital.All postoperative pathological reports were craniopharyngioma.According to clinical classification and growth pattern,different surgical approaches were adopted for surgical treatment.For the patients who could not be completely resected during the operation,We recommend that patients receive gamma knife radiotherapy after the surgery.We use SPSS26 software to process the data,and then we analyze the respective surgical techniques,the ideal management of craniopharyngiomas and effect of recurrence on total resection rate of craniopharyngioma.Results: Our study collected 144 patients with craniopharyngioma.The number of male and female patients were 73 and 71 respectively.The age distribution is from 3 to 84 years old.The average age of these patients was 45.4 years old.There were 12 children and 132 adults in this study.This study included 115 cases of primary craniopharyngioma.There were 29 cases of recurrent tumor.Transsphenoidal approach was used in 4 cases,pterional approach in 81 cases,subfrontal approach in 9 cases,longitudinal fissureendplate approach in 38 cases and corpus callosum-fornix approach in 12 cases.The total resection rates of the two main surgical approaches were analyzed: In 81 patients with pterional approach,58 patients underwent total tumor resection,with a total resection rate of 71.6%.In 38 patients with longitudinal fissure-endplate approach,25 patients underwent total tumor resection,with a total resection rate of 65.8%.Statistical analysis showed that the difference of total resection rate between the two groups was not statistically significant(X~2=0.415,P>0.05).Total resection was performed in 79 of 115 cases of primary craniopharyngioma,achieving a total cutting rate of 68.7%.Total resection was performed in 9 of 29 cases of recurrent craniopharyngioma,achieving a total cutting rate of 31.0%.Statistical analysis showed that the total resection rate in the recurrent group was significantly lower than that in the primary group(X~2=13.822,P<0.05).This study actively recommends gamma knife stereotactic radiotherapy for patients who can not be completely resected.No radiotherapy was given after total resection of the tumor.We define group A as total resection of the tumor.We set group B as gamma knife radiotherapy after subtotal resection/most resection of the tumor and group C is for subtotal resection/most resection without gamma knife radiotherapy.We followed up all these patients,and the follow-up period ranges from 3 to 60 months.Due to the loss of follow-up,129 patients were followed up at last.The recurrence rates of group A,B and C was 14.8%,27.6% and 63.2%,respectively.Through statistical analysis(X~2=19.438,P<0.05),the recurrence rate was not exactly the same among the three groups.We make a pairwise comparison of three sets of data.Group A is not obvious different from group B in terms of recurrence rate(X~2=2.341,P>0.05).Group A is obvious different from group C in terms of recurrence rate(X~2=19.719,P<0.05).Group B is obvious different from group C in terms of recurrence rate(X~2=5.976,P<0.05).Conclusion:(1)On the premise of avoiding serious complications,total resection of tumor is the best treatment for craniopharyngioma.This scheme can effectively control tumor recurrence.(2)there are many surgical approaches for craniopharyngioma.Pterional approach and longitudinal fissure-endplate approach are widely used.There was no significant difference in total resection rate between the two groups.(3)For patients with unresectable tumors,gamma knife radiotherapy can achieve better results in order to control tumor recurrence.(4)Recurrence factors will increase the difficulty of operation,resulting in a decrease in the total resection rate of recurrent craniopharyngioma... |
PDF Full Text Request