Clinical Analysis Of Microsurgical Treatment Of Craniopharyngiomas

Objective:To investigate the effectiveness, and operating techniques of microsurgical treatment of craniopharyngiomas(CPs), classify and analyze the characteristics of the surgical approaches, and summarize the experience of the prevention and treatment of postoperative complications.Materials and Methods:A retrospective analysis of clinical data and its follow-up of227cases of microsurgical treatment of CPs, which were operated from March,2004to December,2012by professors from the neurosurgical department of the Second Xiang-Ya Hospital. Admitted criteria:had no history of such kind of surgery or radiotherapy and chemotherapy before, and postoperative results were pathologically confirmed CP. Based on certain statistical methods, a thorough research was done on detailed preoperative evaluation before the surgery, as well as the approaches, preoperative, postoperative supporting processes and follow-up study of all227cases.Results:1. In these227cases, there are125male patients,102female,170adults (age≥18years old) and57children(age<18years). And the male to female ratio is about1.23:1, and adult to child ratio is about2.98:1. The oldest one is66years old, youngest3years old, with a mean age of30.6years old; and the history of illness ranged from1week to6years, with an average time of3.5months.The first major symptom distribution was:intracranial hypertension symptoms:such as nausea, vomiting,159cases (70.0%), headache in187cases (82.4%), optic disc edema in6cases (2.6%); the focal compression symptoms: visual acuity and/or with136cases of vision impairment(59.9%), growth retardation in21cases (9.3%) to excessive lactation9cases (4.0%), polydipsia and polyuria in95cases (41.9%), menstrual disorders were seen in28patients (12.3%), and low libido in11cases (4.8%); drowsiness, confusion or coma patients with5cases (2.2%), fever9cases (4.0%). The imaging classification of CP:supradiaphragmatic178cases (78.4%), infradiaphragmatic25cases (11.0%), within the third ventricle14cases (6.2%), intra-and extraventricular mixed type10cases (4.4%).2. Within all of the227cases, gross-total resection achieved in200cases (total resection rate88.1%), subtotal resection in21cases (9.3%), partial resection in6cases (2.6%), there were4deaths within1year after surgery(mortality1.8%). Long-term follow-up was lost in21cases because of varies reasons, total follow-up rate was90.7%. Follow-up time ranged from3months to8years, with an average follow-up period of5.1years, of which57cases (about25.2%) got a follow-up period longer than5years.3. In an examination3days after surgery,97cases of187(51.9%) who had preoperative headache improved. In those who had preoperative visual acuity (vision) disorders:21cases of136(15.4%) deteriorated, uncertainty in7cases (5.1%), a significant improvement in visual acuity in108cases of136patients (79.5%). There138cases of227patients whose pituitary stalk were expressly reserves during operation, which accounting for60.8%,48cases(21.1%) were not determined,41cases of227(18.1%) were not retained. After resection,187cases of227patients(82.4%) suffered from a temporary period of diabetes insipidus, and all returned to normal after2-4weeks’treatment.95cases(41.9%) suffered from postoperative water-electrolyte disorder, and hyperglycemia, and10cases (4.4%) had an onset of hypopituitarism,7patients (3.1%) suffered from a temporary period of oculomotor nerve palsy, yet returned to normal after treatment.Conclusions:1. Microsurgery treatment is an effective and safe method on treating craniopharyngiomas. With the use of microsurgical operating skills and the analysis of the characteristics of different lesions, combined with detailed preoperative evaluation to choose the right approaches and the gaps, satisfactory results can be achieved in the treatment of CPs.2.The main postoperative complications of surgeries of CPs are: fever caused by damages to the hypothalamus, disturbance of consciousness, diabetes insipidus and water and electrolyte balance disorders. As long as the pituitary stalk is carefully reserved in surgery, the risk of the original or new-onset diabetes insipidus and water-electrolyte imbalance after operation can be significantly reduced.3.Improved pterional approach and frontal interhemispheric approach have no significant difference on the effect of tumor resection and postoperative recurrence rate.