Pathomorphological Study And Related Clinical Application Of Craniopharyngioma Based On QST Classification

Objective:According to QST classification of craniopharyngiomas,to explore the relationship between craniopharyngioma and hypothalamic-pituitary axis,to determine the clinical impact of the site of tumor origin in primary craniopharyngiomas and explore the surgical approach strategy of craniopharyngioma of suprasellar origin.Methods:Based on the point of origin,the craniopharyngiomas was labelled as Q,S,or T,the clinical data,surgical video and related image data of 46 primary craniopharyngioma patients undergoing total tumor resection from Jan 2017 to Dec 2020 at Neurosurgery Department of Nanfang Hospital,Southern Medical University were analyzed.Tumor tissue samples were taken and labeled from all patients during operation to investigate tumor and hypothalamic-pituitary axis relationship using hematoxylin and eosin and immunofluorescence staining and related cell state.Patients from six national institutions who had undergone resection for primary craniopharyngiomas were enrolled from Mar 1997 to Dec 2012,the effects of different origins on its clinical manifestations,surgical approach and related prognosis were compared.Patients with primary suprasellar origin craniopharyngioma in neurosurgery of Nanfang Hospital from June 2012 to February 2019 were prospectively collected.The corrider index was defined according to the optic chiasmatic pituitary space and the maximum diameter ratio of the tumor examined parallel to the optic chiasmatic pituitary.The effects of different surgical methods and the craniopharyngioma with different point of origin on the postoperative hypothalamic state,recurrence rate and postoperative quality of life of suprasellar craniopharyngioma were compared.Results:The pia mater,arachnoid membrane,and dura mater,could be seen to separate the third ventricle floor from type Q tumors,type Q tumor pushing adenohypophysis.The pia mater and arachnoid membrane could be found between type S tumors and the third ventricle floor.Type T tumors can be involved in the upper part of the pituitary stalk,pia mater could be found between type T tumors and the third ventricle floor;however,at the origin point of the tumor,pia mater could be loosened,some type T tumors compressed the third ventricle,but the ependymal layer remained intact and a layer of gliosis was observed between the tumor and the third ventricle floor,in which microglia can infiltrate and activate.Among the 529 patients with primary craniopharyngiomas,symptoms,age,histopathology type,tumor size,the incidence of hydrocephalus,survival rates,and recurrence-free survival rates were significantly different among tumors originating in different locations.Patients with type T tumors had higher symptom rates of hypothalamic dysfunction,while those with type Q tumors had higher rates of hormone deficits during preoperative and postoperative management.Type S tumors were correlated with better outcomes and lower recurrence rates.A total of 251 cases of suprasellar origin tumors were included in study,including 66 cases of type S tumors(31 treated endoscopic endonasal approach(EEA),35 treated transcranial approach(TCA),185 cases of type T tumors(88 treated EE A,97 treated TCA).There was no significant difference between EE A and TCA in the overall degree of surgical resection(P=0.634),recurrence rate(P=0.972),pituitary stalk retention rate(P=0.144),postoperative hypothalamic state(P=0.094)and postoperative quality of life(P=0.666),EEA group showed better visual results in type S(p=0.027)and type T(P=0.002)group.In type S tumors,EEA and TCA had no significant difference in pituitary stalk retention(P=0.078),postoperative hypothalamic state(P=0.405)and postoperative quality of life(P=0.721).Among type T tumors,in the low CI group,the retention rate of pituitary stalk(P<0.001),postoperative hypothalamic state(P=0.001)and postoperative quality of life(P=0.018)in TCA group were better than those in TSA group.Conclusion:The membranous layers between craniopharyngiomas of different origin and hypothalamic pituitary axis are different.The origin of craniopharyngiomas effects the choice of surgical approach and prognosis.Individualized surgical strategies for suprasellar origin craniopharyngioma according to the growth mode of the tumor are necessary.