The Clinical Analysis Of The Frameless Stereotactic Interstitial Radiotherapy Technology For The Treatment Of Recurrent Craniopharyngioma

Objective: The objective of this thesis is to guide the choice of surgical treatment, understand the treatment effect, summary treatment experience through the clinical analysis of the frameless stereotactic interstitial radiotherapy technology for the treatment of recurrent craniopharyngioma.Methods: Through the retrospective analysis of the 67 patients from the Navy General Hospital neurosurgery from January 2009 to January 2010 who underwent CAS-R-2 frameless stereotactic apparatus surgery with recurrent craniopharyngioma inter-row internal radiotherapy, and according to the tumor growth area, tumor cavity volume, etc, the author will implement three different ways of drug delivery, which are respectively frameless stereotactic puncture pumping fluid + 32 P colloid interstitial internal radiotherapy(the cystic fluid of patients is 5-15 ml), frameless stereotactic Ommaya capsule implant + liquid pump + 32 P colloid in the interstitial radiotherapy, and frameless stereotactic outside the lumen catheter drainage + 32 P colloid in the interstitial radiotherapy. According to the individual set to dose, the author carries on the post operation follow-up by telephone, or network follow-up, review of head CT or MRI during the period of post operation to 5 years after surgery, also analyses the different pathological types of recurrent craniopharyngioma comparative, and mainly observes the tumor control rates and the rate of tumor recurrence.Results: All of the 67 cases are recurrent craniopharyngioma, one of which has received surgical operation treatment, 39 cases of which are ameloblastic, 17 cases of which are squamous papillary type, 11 cases of which are mixed type in, and all of them have the preoperative visual acuity vision obstacles, including 4 cases of blind, 49 cases of increased intracranial pressure, 41 cases of more drink urine, 11 cases, of sexual function decline, 8 cases of milk secretion, 11 cases of menopause growth obstacles, 21 cases the merger of obstructive hydrocephalus, 42 cases of routine frameless stereotactic puncture pumping fluid + 32 pinterstitial radiotherapy, 19 cases of routine frameless stereotactic Ommaya capsule implant + liquid pump + radiotherapy, 6 cases of underwent frameless stereotactic outside the lumen catheter drainage + 32 pinterstitial radiotherapy, 8 cases of the 67 patients have head discomfort in the process of operation during suction fluid caused by intracranial pressure change, after stop sucking, the symptoms disappears or relieves. And the postoperative examination of head CT can clearly shows a lessening of cystic cavity volume, no operation hemorrhage, but part of the patients’ postoperative CT shows that the area has a small pneumatosis, all of the clinical symptoms have varying degrees of ease after surgery. And 59 cases of Visual impairment have been improved after operation, 22 cases of more drink more urinary symptoms have been improved, 3 cases of decreased sexual function have been improved, 6 cases of menopause lactation have been improved, 2 cases of growth obstacles in the follow-up have developed normally, 10 cases of obstructive hydrocephalus patients ventricle form gradually narrowed, 11 cases will have Ventricle peritoneal shunt whose hydrocephalus has not been improved. In the 67 cases the author has followed from discharge of the seventh month to five years after operation, 37 cases are recurrence, including 18 cases relapse 2 times, 11 cases relapse 3 times, and 4 cases of death. According to particular case of the recurrent tumors, recurrent patients will take the stereotactic operation again or other surgical treatment and 7 cases are lost in the follow-up.Conclusion:Frameless stereotactic interstitial internal radiotherapy has some advantages in the treatment of recurrent craniopharyngioma, small trauma, accurate positioning, short surgical curative effect, and for cystic craniopharyngioma, especially recurrent cystic craniopharyngioma, it is an effective treatment method and operation method. Surgery with the radiation treatments, there has been a certain amount of patients have satisfactory therapeutic effect.