Objective. To explore an effective method of surgical management of craniopharyngioma. Subjects and methods. Fifty patients with craniopharyngioma had total andsubtotal tumor ectomy. There were 29 males and 21 females...Objective. To explore an effective method of surgical management of craniopharyngioma. Subjects and methods. Fifty patients with craniopharyngioma had total andsubtotal tumor ectomy. There were 29 males and 21 females, ranging in age from 15 to 56 years (mean 34.1 years). MR imaging showed that the tumors were locatedin the superior sellar region in 24 cases, in superior sella region and extended into the third ventricular floor in 19 cases, into parasella in 3 cases and down to intrasella in 4 cases. Complete cystic tumors were found in 5 cases, whilethe partial cystic tumor in 24 cases and complete solid tumors in 21 cases. Pterional approach was used in 48 patients and subfrontal approach in 2 patients. Great attention was paid to the preservation of the perforating arteries from thecarotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures. The clinical outcome was evaluated according to the GOS scale.Results. Of the 50 patients surgically treated, 47 patients obtained total ectomy of the tumor and 3 patients with the secondary surgery had subtotal ectomy of the tumor. The pituitary stalk was preserved in 29(58%) patients, severed in 14 patients and unidentified in 7 patients. Forty-six patients regained a normal life; one patient needed assist in life. Of the 3 deaths, one patient died of diabetes insipidus, one of inhalation asphyxia, and another one of water and sodium disorders. Conclusion. Avoidance of the injury to the neural structures in the thirdventricular floor and preservation of the perforating arteries to hypothalamus are the key to achieve good surgical results in treating craniopharyngioma.展开更多
Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patien...Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group. The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow up after operation were compared between the two groups. Results: Fifteen patients ( 15.6 %) died in the standard large trauma craniotomy group and 30 ( 27.7 %) in the routine craniotomy group. The postoperative mean ICP was 3.75 kPa±1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa±1.57 kPa in the routine craniotomy group. The pupil rebound was found in 47 patients ( 61.0 %) in the standard large trauma craniotomy group and in 41 patients ( 46.1 %) in the routine craniotomy group (P< 0.01 ). The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long term therapeutic effect was found between the two groups. Conclusions: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma . The incidence of complication can also be decreased. But the long term life quality of the patients can not be improved.展开更多
文摘Objective. To explore an effective method of surgical management of craniopharyngioma. Subjects and methods. Fifty patients with craniopharyngioma had total andsubtotal tumor ectomy. There were 29 males and 21 females, ranging in age from 15 to 56 years (mean 34.1 years). MR imaging showed that the tumors were locatedin the superior sellar region in 24 cases, in superior sella region and extended into the third ventricular floor in 19 cases, into parasella in 3 cases and down to intrasella in 4 cases. Complete cystic tumors were found in 5 cases, whilethe partial cystic tumor in 24 cases and complete solid tumors in 21 cases. Pterional approach was used in 48 patients and subfrontal approach in 2 patients. Great attention was paid to the preservation of the perforating arteries from thecarotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures. The clinical outcome was evaluated according to the GOS scale.Results. Of the 50 patients surgically treated, 47 patients obtained total ectomy of the tumor and 3 patients with the secondary surgery had subtotal ectomy of the tumor. The pituitary stalk was preserved in 29(58%) patients, severed in 14 patients and unidentified in 7 patients. Forty-six patients regained a normal life; one patient needed assist in life. Of the 3 deaths, one patient died of diabetes insipidus, one of inhalation asphyxia, and another one of water and sodium disorders. Conclusion. Avoidance of the injury to the neural structures in the thirdventricular floor and preservation of the perforating arteries to hypothalamus are the key to achieve good surgical results in treating craniopharyngioma.
文摘Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group. The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow up after operation were compared between the two groups. Results: Fifteen patients ( 15.6 %) died in the standard large trauma craniotomy group and 30 ( 27.7 %) in the routine craniotomy group. The postoperative mean ICP was 3.75 kPa±1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa±1.57 kPa in the routine craniotomy group. The pupil rebound was found in 47 patients ( 61.0 %) in the standard large trauma craniotomy group and in 41 patients ( 46.1 %) in the routine craniotomy group (P< 0.01 ). The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long term therapeutic effect was found between the two groups. Conclusions: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma . The incidence of complication can also be decreased. But the long term life quality of the patients can not be improved.
