颅咽管瘤外科治疗方法选择的探讨

SELETIVE TREATMENT MODALITIES FOR CRANIOPHARYNGIOMA

目的探讨颅咽管瘤的微侵袭治疗方法的选择及并发症。方法 :4 6例颅咽管瘤患者 ,30例行显微手术切除 ,其中 2 5例行全切除 ,5例行大部分切除后予γ刀治疗 ,6例行单纯γ刀治疗 ,10行MRI立体定向囊内放射治疗。结果 :手术组 2 5例全切除患者 ,术后 2 1例恢复正常工作 ,2例需生活照顾。随访 2年以上 16例 ,CT或MRI检查未见肿瘤复发 ,2例死亡 ,其中 2例死于下丘脑损害。γ刀治疗组 11例患者临床症状明显改善 ,随访 6～ 30个月 ,MRI检查显示 4例肿瘤完全消失 ,5例缩小 ,2例无变化 ,无术后并发症。囊腔放疗组 10例经手术排除囊液后临床症状明显改善 ,随访 3～ 30个月 ,MRI显示 3例肿瘤完全消失 ,7例瘤腔明显缩小 ,无手术死亡率及严重并发症。结论 :显微手术全切除颅咽管瘤仍是目前理想的治疗方法 ,γ刀治疗适用于实质性和部分实质性 ,体积较小 (<3～ 4cm)的肿瘤。对囊性体积较大的颅咽管瘤行立体定向囊腔内放疗是一种十分安全有效的方法。

Objective:To study selective treatment modalities and complications of craniopharyngioma.Methods:We analysed 46 patients with craniopharyngioma.Among the 30 cases operated microsurgically,25 cases were treated by total resection,5 cases were treated by Gamma Knife after subtotal resection.Six cases were solely treated by Gamma knife.Ten cases were treated with MRI-guided stereotatic intracavitary irradiations with 32P.Results:After total resection,follow-up results showed that 21 patients resumed nomal lives,2 patients needed assistance,and 2 died from impair of hypothalamus.Sixteen cases were not seen any recurrence of tumor by examination of CT or MRI up to two years.Eleven cases treated by Gamma knife were followed up for 6 to 30months.Reexamination of MRI manifested disppearance of tumor in 4 cases,shrinkage in 5 cases and no growth in 2 cases.To 10 cases treated with intracavitary irradiation,follow-up (ranged from 3 to 30 months) MRI manifested dispearance of tumor cyst in 3 cases,shrinkage in 7 cases.No mortality or severe complication occured.Conclusions:Microsurgery can not be replaced by other therapies.To smaller parenchymal mass (diameter<4cm) and incompletely resected craniopharyngioma,Gamma kinfe radiosurgery is effective in controlling tumor growth and symptomatic recurrences.To larger cystic craniopharyngioma,MRI-guided stereotatic intracavitary irradiation is a safe and effective mehtod.