X Shi1, Z Wang. 1. Department of Neurosurgery, Affiliated Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Abstract
OBJECTIVE: To study the effective method for surgical treatment of craniopharyngioma. METHODS: 110 patients with craniopharyngioma were operated on. Their tumors were totally removed. Of the 110 patients, 62 were male and 58 female, with age ranging from 15 to 67 years (mean 34.4 years). Pterional approach was performed in 102 patients, subfrontal approaches in 5, and transcallosum into the anterior third ventricle part in 3. The perforating arteries from the carotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures were preserved when the tumors were excised by pterional approaches via the parachiasmal opticocarotid, carotidotentorial spaces and by opening the lamina terminals. The neural structures of the third ventricular floor were preserved by the transcallosum approach to the anterior part of the third ventricular floor. The cystic fluid was initially aspirated from cystic tumors, solid portion of the tumor was excised by piecemeal and calcification mass was crushed for removal. RESULTS: Of the 110 patients, 101 had a total removal of tumor, 7 a subtotal removal of tumor, and 3 a partial removal of tumors. The pituitary stalk was preserved in 57 patients, ruptured in 29, and unidentified in 24. In 54 patients with diabetes insipidus after surgery, 52 recovered from 3 months to one year after surgery and only two patients failed to over one year after surgery. 52 patients had normal blood sodium level 3 months after surgery. Three patients after surgery had decreased visual acuity. In 3 patients with oculomotor paralysis after surgery, one failed recover till one year. Two patients after surgery had temporal paralysis of the extremities. All the patients after surgery were followed up for one month to five years (mean, 1.1 years). Four patients died after surgery. CONCLUSIONS: The proper surgical approaches for the removal of craniopharyngiomas are the key to achieve good surgical results and avoid the injury to the hypothalamic structures and the perforating arteries to hypothalamus.
OBJECTIVE: To study the effective method for surgical treatment of craniopharyngioma. METHODS: 110 patients with craniopharyngioma were operated on. Their tumors were totally removed. Of the 110 patients, 62 were male and 58 female, with age ranging from 15 to 67 years (mean 34.4 years). Pterional approach was performed in 102 patients, subfrontal approaches in 5, and transcallosum into the anterior third ventricle part in 3. The perforating arteries from the carotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures were preserved when the tumors were excised by pterional approaches via the parachiasmal opticocarotid, carotidotentorial spaces and by opening the lamina terminals. The neural structures of the third ventricular floor were preserved by the transcallosum approach to the anterior part of the third ventricular floor. The cystic fluid was initially aspirated from cystic tumors, solid portion of the tumor was excised by piecemeal and calcification mass was crushed for removal. RESULTS: Of the 110 patients, 101 had a total removal of tumor, 7 a subtotal removal of tumor, and 3 a partial removal of tumors. The pituitary stalk was preserved in 57 patients, ruptured in 29, and unidentified in 24. In 54 patients with diabetes insipidus after surgery, 52 recovered from 3 months to one year after surgery and only two patients failed to over one year after surgery. 52 patients had normal blood sodium level 3 months after surgery. Three patients after surgery had decreased visual acuity. In 3 patients with oculomotor paralysis after surgery, one failed recover till one year. Two patients after surgery had temporal paralysis of the extremities. All the patients after surgery were followed up for one month to five years (mean, 1.1 years). Four patients died after surgery. CONCLUSIONS: The proper surgical approaches for the removal of craniopharyngiomas are the key to achieve good surgical results and avoid the injury to the hypothalamic structures and the perforating arteries to hypothalamus.