Microneurosurgical Treatment Of Craniopharyngioma In177Cases:a Study Of The Longterm Surgical Results And Related Factors

Object:The optimal treatment of craniopharyngioma still arouse controversy. This study collected clinical and follow-up data of177cases operated by senior neurosurgeon Professor Yuan xianrui during2003and September of2013.Analysis statistically the predictors of overall survival rate,recurrence rate and functional outcome.Summarize treatment experience,explore the best treatment method preliminarily.Method:Collect clinical and follow-up data of177cases operated by senior neurosurgeon Professor Yuan xianrui during2003and September of2013,follow up data including survival status,MRI was used to detect tumor recurrence.Neurological status,visual function, pituitary and hypothalamus function, education or occupation state were evalued to know the patients’overall functional deficit and quality of life. Kaplan-Miere analysis was used to measure overall survival and progression free survival.The functional outcome was transformed into scores according to CCSS(Craniopharyngioma clinical status scale). log-rank test and Cox propotion hazard model were used to determine adverse factors of poor outcome.Results:185operations were carried out on177patient by one senior neurosurgeon,including162primary tumor and21recurrent tumor.Unilateral subfrontal approach was adopted in169cases(91.35%), the goal of gross total resection were achieved in167cases, yielding GTR rate as94.35%,there were3perioperative death(1.7%).At the end of follow up,date can be obtain in161patients, mean duration of follow up is47.23month,21death were found during the follow up,overall mortality is14.9%,10year OS is85.1%,20patients experienced recurrence(12.7%),5year PFS is80%.86.7%patients can maintain education or employment or be independent.Adverse factors of survival are subtotal or partial resection,involvement of the third ventricle. Adverse factors of recurrence are subtotal or partial resection, recurrent tumors,the tumor arise in the sella turcica.Conclusion:1.Gross total resection can gain long term survival and tumor control,maintaining good function status.2.Unilateral subfrontal approach in junction with the space of prechiasmatic,the space between optic chiasma and carotid artery,trans lamina-terminalis can achieve total resection in most types of tumors.3. Extent of resection and involvement of third ventricule are adverse factors of survival,recurrent tumors extent of resection and origin with sella turcica are predictors of recurrence.4.Proper postoperative management and disease education,regular follow up are beneficial to lower mortality and improve quality of life.