The Vaule Of Qi's Score In The Operation Of Recurrent Craniopharyngioma

Craniopharyngiomas is the most common congenital tumor, representing 4.7%-6.5% of intracranial tumor for the whole age stage, amounting to about 50% of pediatric cases. Although this tumor is benign in histology, poor result is common for difficult treatment, which influences seriously the life quality and survival of patients. Dispite many scholar have studied craniopharyngioma deeply for almost one hundred years, recurrence and serious complication resulting from the injury of surrounding structure postoperationly are still the main challenge for neurosurgeon. There are many controvert for treatment of recurrent craniopharyngioma which focus on the option of operation. At present, operation has been proverbially accepted as a treatment option of recurrent craniopharyngioma. In this study, 26 patients with recurrent craniopharyngioma in Nanfang hospital between Janury 1996 and June 2003 were studied. The related factors and the value of Qi's score in operation for recurrent craniopharyngioma were investigated. It was concluded that Qi's score was instructive for the operation and radical resection was especially important.ObjectiveThere are many related factors that influence craniopharyngioma to recrudesce after operation. To understand accurately the difficulties, Qi made a quantitative analysis for the resection of craniopharyngioma. In this study, the related factors andthe value of Qi's score were investigated.Methods:The data of 26 patients with recurrent craniopharyngioma operated by professor Qi in Nanfang hospital between Janury 1996 and June 2003 were studied. The integrated clinical and follow-up data were all included.1 The clinical data, including hormone level, urinary output, neuro-imaging data, ophthalmology work-up, both preoperatively and postopratively, were collected and analysed.2 Acoording to Qi's score, these data were classified again. The difficulties were evaluated between preoperatively and postopratively.3 The character and principle of operation were summarized according to the clinical data and video-tape of the operation.Results:These 26 patients with recurrent craniopharyngioma were all operated. Of them, 20 patients were total resected, 4 patients were subtotal resected, 2 patients were partial resected. All of them survived. The pathlogical results were all adamatinomatous craniopharyngioma.All these patients experienced pituitary/hypothalamic deficits differently. 17 of 20 patients with diabetes insipidus got better after treatment. 3 patients needs long term antidiuretic hormone. 15 patients with electrolytic imbalance were cured. 18 patients with preoperative pituitary dysfunction had no change after operation. 20 patients with postoperative pituitary dysfunction were all given hormone treatment. Of 6 patients with preoperative visual deficit, 2 got better after operation, 2 had no change, 2 got worse. Neuroimaging data demonstrated no recurrence after 20-97 months follow-up. 19 patients can lead independent life. 7 patients need help.ConclusionFrom pathological features, tumor position and the relation with third vintricle, Qi's score made a quantitative analysis for craniopharyngioma which can help the operator understood accurately the difficulties of resection. Using Qi's score in operation, neurosurgeon can make individual treatment for patients through utilizing different technique, especially for patients with high scores, the rate of total resection increased with little complication. Comparing with preoperative condition, both the hormonal level and the diabetes insipidus have nothing to do with the second operation.Qi's score of recurrent craniopharyngioma disclosed that tumor would have high scores if the growing direction of tumor was considered. The recurrent tumors always lay in areas difficult accessible in first operation and adhered tightly with surrounding structure. The adhesion with hypothalamus presents in areas where the first operation was conducted. On the contrary, no adhesion occurred in areas not touched in the first operation. The adhesion often lay in recurrent site. For patients with high scores, it required extended surgical approach to decrease the risk of damaging brain. In the operation, the structures of hypothalamus, such as pituitary stalk, infundibulm, median eminence, tuber cinereum and mammallary body, should be protected .The injuries of superior hypophysealartery, anterior thalamoperforating artery, posterior thalamoperforating artery should be avoided. The key factors of successful operation are the anatomy knowledge and microsurgery technique of the operators.In the operation of recurrent craniopharyngioma, it was found that there is no normal tissue between tumor and bottom of third ventricle, the tumor adhered to posterior communicating artery, so it is easy to damage posterior cerebral artery, basilar artery and posterior thalamoperforating artery, which can cause coma or death after operation.For tumor with 10-12 of Qi's score, because the cacified mass adheres to the hypothalamus tightly, aggressive resection should be avoided. It shoud be dissected sharply to avoid heavy retraction for residul tumor adhered to hypothalamus tightly. If the tumor was found earlier with smaller volume which Qi's score was low, it is easy to be resected. So aggressive resection should be avoided for the tumor which score was very high, especially for the tumor adheres to the important structure tightly. Other adjuvant treatment is helpful.Surgery is the most preferential option for the treatment of recurrent craniopharyngioma. If there are no serious complications occurred, it is necessary to resect the tumor as radical as possible.