| Craniopharyngioma(Craniopharyngioma,CP)is a common central nervous system tumor in the saddle area that is classified as WHO class I,it has the biological behavior of malignant tumor,prognostic management remains a problem.From the first case of craniopharyngioma surgery(Halstead,1909)to now,after nearly 100 years of development,its postoperative still has more complications and higher recurrence rate,and its treatment effect is still not satisfactory.There is a clear difference between the effects of surgical treatment,and surgical treatment remains a challenge for every neurosurgeon.How to correctly understand the influencing factors of craniopharyngioma postoperative prognosis will undoubtedly help preoperative preparation,intraoperative guidance and postoperative management of craniopharyngioma.From the collection of literature and data,there is currently no extremely effective treatment plan and recognized prognostic assessment related factors.Postoperative evaluation of craniopharyngioma has been based on other benign tumors in the skull,but craniopharyngioma is located in the hypothalamus.At present,with the progress of microscopic neurosurgery,postoperative death and neurological defects have been Rarely,we believe that the efficacy of craniopharyngioma should be evaluated based on postoperative hypothalamic-pituitary endocrine disorders.Therefore,we creatively proposed the "Graduation Table of Postoperative Curative Effect Evaluation for Patients with Craniopharyngeal Tumor" in2000,based on craniopharynx the scale established after the main complications of tube tumors can better evaluate the therapeutic effect of different treatment centers on craniopharyngioma.Based on the relationship between tumor embryonic origin and peripheral membranous structure,Professor Qi Songtao proposed QST classification to guide the selection of surgical methods and prognosis judgment.Prof.Prieto Ruth from abroad studied whether there is an obvious anatomical separation level and adhesion degree between the CP and the surrounding anatomy,and proposed an adhesion strength classification to improve the surgical plan,pointing out that this classification affects the radicalness and safety of the operation.Recently recognized by many scholars.In this study,the quantification can better compare the efficacy of each group,and there is a strong clinical practical value.In this topic,we discuss the influence of many factors on the prognosis,draw on and combine the two classification methods of adhesion strength and QST,and analyze the patients retrospectively from the degree of adhesion between the craniopharyngioma and the peripheral nerve structure and the location of origin,the clinical characteristics of different classifications,and to explore the relationship between it and the prognosis,deepen the understanding of the anatomy and origin of CP,help to choose individual surgical approaches and treatment options,help predict the difficulty of surgery before surgery,and plan the most good surgical method,to avoid intraoperative risks,improve the success rate of surgery and reduce bad prognosis.Objective: To analyze and discuss the relationship between craniopharyngioma related influencing factors and prognosis,to distinguish between high-risk and low-risk poor prognosis,and to provide assistance in formulating individualized surgical plan,postoperative treatment and prognosis evaluation.Methods: Collected data of 63 patients with craniopharyngioma surgery from the Department of Neurosurgery,Affiliated Hospital of Qingdao University from June 2014 to May 2019,followed up to summarize the endocrine situation,quantified the endocrine prognosis results,and statistically analyzed the related influencing factors such as QST classification,adhesion strength and prognosis Relationship,to explore the impact of various factors on the prognosis of CP patients.Use IBM SPSS Statistics 26.0 statistical software for analysis,according to different types of analysis variables,select the corresponding chi-square test,Mann-Whitney U test,Kruskal-Wallis H test,Logistic regression analysis and other methods for medical statistical analysis.Factors were included in the stepwise regression analysis to screen for statistically significant variables,and ordered logistic regression analysis was performed.The statistical analysis results showed statistical significance with P<0.05 as the difference.Results: Among the 63 CP patients,9(14.29%)were mostly resected,8(12.70%)had subtotal resection,46(73.02%)had total resection,and 3(4.76%)died.Univariate analysis showed that there was no correlation between gender and age and prognosis(P>0.05),the size of the craniopharyngioma,calcification degree,cystic solidity,QST classification,adhesion strength,pathological classification and There was a correlation between the degree of resection and prognosis(P<0.05).Multivariate logistic regression analysis showed that there was a significant correlation between adhesion strength,QST classification,cyst solidity and prognostic classification.Adhesion strength(OR = 13.206,95% Cl: 5.14 ～ 33.931,P <0.01),QST classification(OR = 8.476,95% CI: 2.904 ～ 24.74,P <0.01)and cysticity(OR = 2.03,95% CI: 1.031 ～ 3.997,P <0.05).The adhesion strength and QST classification are more significant than the cystic solid factor,which can be used as a significant risk factor for the prognosis of craniopharyngioma.Conclusion: Adhesion strength and QST classification are important influencing factors for the prognosis of CP,and cystic solidity index is a secondary influencing factor.It is important to fully understand the adhesion strength and QST classification of CP before surgery for the formulation of surgical strategy,treatment plan and prognosis evaluation.Reference value and guiding significance. |
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