The Clinical Analysis Of 152 Cases Of Adult Craniopharyngioma

Research Objective:Craniopharyngioma is a common congenital benign tumor in the sellar region,growing along the pathogenesis of embryonic craniopharyngeal.Although it is a benign tumor,but because of the characteristics of invasive growth,so with closely related to the pituitary,Willis ring,optic chiasm,hypothalamus and other important neurovascular tissue,and difficult to surgical resection,more postoperative complications,the treatment effect is not very satisfactory.In this paper,through a retrospective analysis of clinical treatment of 152 cases of adult craniopharyngioma,to explore the best treatment strategy of the adult craniopharyngioma,the related factors that affect diabetes insipidus and processing of the common complications.Objects and Methods:The clinical treatment of 152 adult craniopharyngiomas was retrospectively analyzed,treated from Neurosurgery of the First Affiliated Hospital of Zhengzhou University from February 2009 to November 2016.The relationship between the degree of tumor resection or the application of radiotherapy and relapse rate,cutting rate of the primary and recurrent craniopharyngioma and the influence factors ofcommon complication of diabetes insipidus after tumor resection(gender,tumor size,prolactin rise,whether or not to retain intraoperative pituitary stalk,etc.)for statistical analysis,To explore the best treatment strategy of the adult craniopharyngioma,and the related factors that affect diabetes insipidus.Results:134 cases were followed up in the group of 152 cases,normal learning,and living were 108 cases currently(follow-up period),Need long-term care,Can not take care of themselves was 16 cases,10 cases were death.In 152 cases,primary craniopharyngioma was 131 cases,while 21 cases were recurrent.Among them,88 males and 64 females,then male to female ratio was about 1.4 : 1.The age of onset varied from 18 to 70 years.The average age of onset was 44.4 ± 13.6 years.The duration of disease was 7 days to 10 years.And mean course of disease was 9.77 months.There were 51 cases used conventional pterygoid or expanded pterional approach,28 cases used frontal approach,42 cases used prefrontal longitudinal approach,and 13 cases used transnasal approach(4 cases used neuroendoscopy),10 cases used forehead corpus callosum-interstitial-fornix approach,6 cases used pterygoid combined with corpus callosum approach,2 cases used cortical fistula approach.98 cases were total resection,39 cases were subtotal resection and most of the resection was 15 cases;In 21 cases recurrent craniopharyngioma,total resection was 6 cases,subtotal resection was 6 cases,most of the resection was 9 cases.The follow-up period ranged from 3 months to 93 months,and a median follow-up period was 61 months.Of the 134 patients who were followed up(no postoperative radiotherapy),13 cases were relapsed;In 47 patients who were most of the resection,27 patients with stereotactic radiosurgery(Gamma knife radiotherapy in other hospital),recurrence was 5 cases;20 cases without radiotherapy or other adjuvant therapy,recurrence was 13 cases.Conclusions:1.The preferred treatment method of adult craniopharyngioma is microsurgicalsurgery.surgery is difficult to complete resection of the tumor can not be too much pursuit of total cut,combined with gamma knife radiotherapy can still achieve satisfactory results.2.Total resection of the tumor,appear diabetes insipidus symptoms preoperative,pituitary stalk remains unclear or not retained in surgery,prolactin increased preoperative,the maximum diameter of the tumors greater than or equal to 3cm may increase the incidence of diabetes insipidus postoperative.3.postoperative complications of craniopharyngioma is common,actively deal with all kinds of complications is key to through perioperative period safety.