Nerve Endocrine Functions Disorder After Microsurgical Resection Of Craniopharyngiomas And Relative Factors

Objective To assess the outcome of nerve endocrine functions disorder after craniopharyngiomas resection and the relative factors influencing the nerve endocrine functions after surgery.Methods A total of 90 patients (50 men and 40 women) with craniopharyngioma were microsurgically removed by Pro.Yuan XR(MD) himself from October 1992 to October 2006. Among them ,67(74.4%) patients were adults, 23(25.6%) were children. A retrospective review was performed. The general information, preoperative symptoms, signs, tumor size, cystic formation, degrees of tumor calcification, nerve endocrine function, etc were recorded. An average of 32 months' follow-up was performed in 51 patients, including 41 patients received total tumor removal, and 10 underwent subtotal or partial removal. And the nerve endocrine function was assessed.Results The average tumor size is 44.52mm . Total, subtotal or partial removal of the tumors were achieved in 71 (78.9%), 13 (14.4%) or 5(5.6%) patients, respectively. Total removal of the tumors were achieved in 51 (91.1%) patients after the year 2001.The pituitary stalk was anatomically preserved in 26 (28.9%) patients. One (1.1%) patient died one day after the surgery. During the follow-up, 3 (7.3%) patients experienced tumor recurrence after total tumor removal, and 4 (40.0%) had recurrent tumor after subtotal or partial resection. Most patients had nerve endocrine function problems of variety degrees and 4(7.8%) patients had recovered completely. Tumor resection, degrees of calcification are correlate with the prognosis and recurrence. Pituitary stalk preservation and hypothalamus protection are correlate with the nerve endocrine functions in the long term.Conclusion Total resection of craniopharyngiomas microsurgically via lamina terminalis approach is a safe and effective method . The mortality, morbidity, and recurrence rate in patients received total resection are lower than those of patients underwent subtotal or partial resections. Those with subtotal or partial resection, bigger caicification and tight adherence have relative poor prognosis and high recurrence rate. Preservation of the pituitary stalk and protection of the hypothalamus are critical correlate with the nerve endocrine function in the long term.