Analysis Of Microsurgical Treatment Of Craniopharyngioma In 59 Cases

Objective: To explore the safe and effective operative approach of microsurgical treatment of craniopharyngioma, the characteristics of epidemiology, clinical manifestations, radiological features, diagnosis and differential diagnosis, microsurgical treatment, pathological types, postoperative complications and management, and follow-up outcome of patients with craniopharyngioma were retrospectively analyzed.Methods:Clinical manifestations, imaging examinations, surgical approaches, tumor resection extent and follow-up data of 59 cases of craniopharyngioma were retrospectively analyzed in Qilu Hospital from January 2006 to March 2009 were retrospectively analyzed. All patients were diagnosed preoperatively by MRI and CT.Results:59 cases of craniopharyngioma,33 cases were male (56%), female 26 cases (44%), male to female ratio 1.27:1. Ages 8 to 67 years, mean 32.5 years; history of 5 months to 12 years, an average of 5.9 years.5 patients (8.5%) were children,2 males and 3 females, aged 8 to 14 years, an average of 8.7 years; history of 5 months to 2 years, an average of 1.2 years. Clinical symptoms of headache (41 cases), visual field of vision disorders (48 cases), pituitary insufficiency (16 cases), diabetes insipidus (7 cases) as the main performance. All patients were taken craniopharyngioma resection under microscope. According to tumor sizes, location, nature and the relationship with surrounding structures. They were used pterional approach in 21 cases (2 cases of intrasellar type,10 cases of intrasellar or suprasellar type,8 cases of suprasellar type), Tumor of 16 cases were totally removed(76.2%), Interhemispheric approach in 20 cases (6 of cases intrasellar and suprasellar type,13 cases of suprasellar type,2 cases of para-third-ventricular type), Tumor of 17 cases were totally removed (85%). 16 cases were taken the trans-frontal-lobe approach (8 cases of intrasellar and suprasellar,7 cases of suprasellar type,1 cases of para-third-ventricular type), Tumor of 8 cases were totally removed (50%),2 cases taken nasal transsphenoidal approach (2 cases of intrasellar type). Tumor of 43 cases (73%) were totally removed,16 subtoally removed. No patients died. Discharged, symptoms of 50 patients were markedly improved, symptoms of 7 patients were not significant eased, and 1 case got worse,1 case got hypothalamic dysfunction, therefore their families gave up continuing treatment. With pterional approach in 21 cases, symptoms were improved in 15 cases (71%), Symptoms of 5 patients were not significantly eased, and 1 case of hypothalamic dysfunction gave up treatment; Interhemispheric approach in 20 cases, symptoms of 19 cases were improved (95%),1 cases was not obviously eased; 16 cases which taken trans-frontal-lobe approach,14 cases were improved (87.5%),1 patients without mitigation, and 1 case got worse; Symptoms of two cases which taken trans-nasal-sphenoidal approach were all improved. All of the 59 patients were followed up for 5 months to 3 years, an average of 2 years,3 cases of subtotal resection were relapsed.45 patients could participate in the daily life.8 cases could take care of themselves,6 cases need help.Conclusions:(1)There was significant difference between different Pathological types of craniopharyngioma in ages and the gross tumor volum. The pathological types of the craniopharyngioma was independent to sex, character and calcification of tumor.(2) Microsurgery treatment is effective, tumor recurrence after resection affecting the most important factor in long-term survival, and the risk of recurrence is related to the degree of tumor resection.(3) The interhemispheric approach in the tumor removal rate is higher than the trans-frontal-lobe approach, improvement in symptoms after interhemispheric approach surgery is more effective than pterional approach. The interhemispheric approach is more safe and effective for removing craniopharyngioma.(4) The most common postoperative complications were diabetes insipidus and electrolyte disturbance.It is necessary to prevent and to treat the complications actively.