成人颅咽管瘤156例的显微手术治疗

Microsurgical treatment of adult craulopharyngiomas in 156 cases

目的探讨成人颅咽管瘤的临床特点、手术方法及治疗效果。方法对2004年1月至2009年3月北京天坛医院神经外科手术治疗的156例成人颅咽管瘤进行回顾性分析。根据肿瘤与鞍膈和第三脑室的关系分为4种类型：蝶鞍内型（6例），鞍上脑室外型（59例），脑室型（63例），复杂型（28例）。手术采用单侧额下人路9例，前纵裂入路14例，翼点入路102例，经胼胝体一脑室人路28例，经蝶窦入路3例。结果肿瘤全切除124例（79．5％），次全切除25例（16％），部分切除7例（4．5％），手术死亡2例。术中垂体柄确认并保护69例，术后出现尿崩症109例（69．8％）。随访3个月至5年，能正常工作和生活占75．3％，肿瘤复发26例。结论根据颅咽管瘤的部位和生长方式，选择合适手术入路是颅咽管瘤手术成功的关键。

Objective To explore the clinical features, surgical approaches and outcomes of craniopharyngioma in adults. Methods A total of 156 cases of adult craniopharyngioma underwent microsurgery at our hospital were retrospectively reviewed and classified into four types according to the location of tumor relative to sellar diaphragm and the third ventricle. They were divided into four groups ： intrasellar type （ n = 6）, suprasellar ＆ extraventricular type （ n = 59）, intraventricular type （ n = 63） and mixed type （n = 28 ）. Unilateral subfrontal approach was chosen in 9 cases, anterior interhemispheric approach in 14 cases, pterional approach in 102 cases, transcallosal approach in 28 cases and transsphenoidal approach in 3 cases. Results Tumors were totally removed in 124 cases （79. 5% ）, subtotally removed in 25 cases （16%） and partially removed in 7 cases （4. 5% ）. Two patients died after surgery. Pituitary stalk was identified and protected intraoperatively in 69 cases, and postoperative diabetes insipidus occurred in 109 cases. The follow-up period ranged from 3 months to 5 years. 75. 3% of the cases were capable of normal work and life and tumor recurred in 26 cases. Conclusion Selection of appropriate approach is the key to successful microsurgery for craniopharyngioma according to the site and growth pattern of tumor.