Treatment Strategies For Craniopharyngiomas

Background and purposeCraniopharyngioma is benign tumor originated from rathke pouch,It isembryonic remnant of epithelial cells. Although benign, but involving hypothalamus,optic nerve and chiasm, pituitary stalk, and the upper sellar region along with3rdventricle; treatment is not very optimistic. Retrospective analysis of different methodsof treatment of craniopharyngioma, observe treatment effect and complications;explore the best treatment of craniopharyngioma and its influencing factors.Material and methodsA retrospective analysis of craniopharyngioma cases at first affiliated hospital ofZhengzhou hospital from December2008to December2013;120patients under wentmicrosurgical resection, postoperative pathological report confirmed as craniophary-ngioma. Patient’s sex, clinical symptom before and after surgery, endocrine function,tumor size and nature, surrounding anatomy, radiological features, extent of tumorresection, complication and prognosis of treatment of craniopharyngioma wereanalyzed.ResultsThis group of patients of craniopharyngioma,63was children’s from5to15years of age and an average of9years old,30female and33male;57cases wasadults,57-71years old and average of59year,31male and26female. At time ofadmission, main clinical manifestation were61cases with visual impairment,58withheadaches,15with polydipsia and polyuria,13with menstrual disorders,20with growth retardation,8with impotence,6with short term amnesia,2with limbweakness,2with oculomotor nerve palsy, discovered during physical examination.120cases of craniopharyngioma patients underwent surgical resection;82patientswith complete resection,26patients with subtotal resection, and12patients withpartial resection;82patients with total resection6patients relapsed (7.3%),38patients with subtotal and partial resection21patients underwent stereotacticradiotherapy2patients relapsed,17patients without stereotactic radiotherapy11patients relapsed. Pterion approach in90cases, subfrontal approach in12cases,callosotomy in8cases, transshenoidal approach in3cases. According to preoperativeimaging and intra operative observation61cases with calcification, accounting for50.8%, no calcification in49cases, accounting for49.2%; cystic and solid tumor in95cases accounting for79.2%, solid tumor in25cases accounting for20.8%;40patients with preoperative hydrocephalus33.3%,80patients without hydrocephalus66.7%. tumor ranging from1-7cm average of2.95±1.35cm.ConclusionMicrosurgery is preferred method of treating craniopharyngioma, if tumor walland pituitary stalk, optic nerve and chiasm, hypothalamus and other importantstructure in close adhesion, claims cannot forcibly remove, little residual tumor thenstereotactic radiotherapy is best method.High incidence of post operative complication of craniopharyngioma such aspituitary dysfunction, diabetes insipidus, electrolyte disturbances, thermoregulationimpairment, upper gastrointestinal hemorrhage, epilepsy etc., management ofcraniopharyngioma complication increases prognosis of survival and quality of life.Pituitary stalk can define whether to keep the extent of damage to thehyothalamus.