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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Surgical experience of 179 cases with craniopharyngiomas
Xiang'en Shi1, Yongli Zhang, Bin Wu
1Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, China. yuew@public.fhnet.cn.net
Objective:
To retrospectively review 179 cases surgical treatments of craniopharyngiomas over a 7-year period, surgical experience as following.
Methods:
Dependent on the locations of the tumors to the floor of the third ventricle, they were classified into the superior type of the third ventricle floor in which tumors grew on the superior part of the third ventricle floor, and the inferior type of the third ventricle floor in which tumors grew from the pituitary stalk, infundibulum, tuber cinereum upwards the floor of the third ventricle developing the obstruction of the third ventricle or downward to the intral sella through the foramen of sellar septum. As the tumor of the inferior type, the pterional approaches were performed in 150 patients and the subfrontal approach in 16 patients. As the superior type, transcallosum into the anterior third ventricle part were undergone in 13 cases. Great care was made to preservie the perforating arteries to the neural structures of the third ventricular floor for the tumor of the inferior type. Avoidance of injury was required to the neural structures of the third ventricular floor when used by the transcallosum approach to the anterior part of the third ventricular floor for the tumor of the superior floor.
Results:
Total, subtotal and partial removal of the tumor was achieved in 161, 12 and 6 patients, respectively. Four (2.2%) deaths occurred at early postoperative stage. All patients were followed-up from 3 months to 5 years (mean, 1.5 years), with 154 (88%) patients regained normal life, 14 (8%) had their self-life and the 7 (4%) need assist life. Seven (3.9%) patients experienced their tumor recurrence on MR imaging by following-up. Of them, 4 patients were followed up their tumor recurrence within half-year and 3 patients within one year. Five patients with recurrent tumor were reoperated on and the other 2 patients were undergone the external radiation of the tumor and gamma-knife of the tumor respectively.
Conclusion:
Craniopharyngiomas can be treated surgically with a good result. It is the key to avoid injury of the hypothalamic structures and preserve the perforating arteries to hypothalamus to achieve good surgical results, while attempt was made to completely remove the tumor.
