The Approach Of The Operation Of The Craniopharyngioma (The Analysis Of 67 Case)

Objective To investigate the surgical approach selection for craniopharyngioma,and explore the mannagenent experience in operation.Methods Sixty—seven patients with craniopharyngiomas including forty men and twenty women ,from two years to sixty—seven years. The patients were operated on via diferent approaches,including transsphenoidal approach in 2, pterional in 55 cases,subfrontal in 1 ,transfrontal interhemispheric in 6, ,and transcallosal—interseptal—interforniceal in 1.Results Total removal of the tumor was achieved in 56 cases(83.5%),subtotal in 9(13.5%),and partial in 2(2.9%).After the surgery,headache completely relieve.The total preoperative visual disorder of 48 develop following , deterioration in 7(14.5%),improvement in 37(77.1%),uncertainty in 4(8.3%).Stalk hypophaysial reservation in 33(49.3%), uncertainty in 18(26.7%),unreservation in 16(24.1%).Major postoperative complications included diabetes insipidus in 42 cases an, electrolyte disturbance in 32,hyperthermy in 8,epilepsy in 3,conscious disturbance in 2,oculomotor nerve plegia in 3 ,leakage of cerebrospinal fluid in 1 and death in 3.ConclusionOperation approach As a complementary approach , the transsphenoidal approach is applied to the tumer under the diaphragma of sella turcica. Its weakness is cerebrospinal rhinorrhea. The pterional approach is the main operation approach ,is applied to most of craniopharyngiomas except the intraventricular ones. However, we found that the approach may affect the oculomotor nerve and complicate temporary oculomotor nerve palsy. The transcallosal—interseptal—interforniceal approach is applied to the tumor in the third ventricle of cerebrum .But this approach require skilled operator of excellent microsurgical techniques. The subfrontal approach is applied to the tumer in the anterior of stalk hypophysial .But this approach is replaced gradually by the pterional approach .the transfrontal interhemispheric approach is applied to the tumor above diaphragma of sella turcica and before the third ventricle of cerebrum.The reservation of the stalk hypophysial. The reservation case is recovered more quickly than the unreservation ones in diabetes insipidus and electrolyte disturbance,also in endocrineThe management of blood vessel . The blood vessel from the Willis artery is required to protect carefully in operation ,except the ones entering into the tumer.we can apply cardoverine in operation and Nimodipine after operation to prevent the angiosapsm.In a word ,choosing appropriate approaches is helpful to directly expose and totally remove the craniopharyngioma . Reservation of the stalk hypophaysial and right management of vessel surrounding the tumor may prevent postoperative complications partly.