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An Analysis of Related Factors of Surgical Results for Patients with Cranioharyngiomas

Author: ZhaoXinTong
Tutor: ZhaoHongYang
School: Huazhong University of Science and Technology
Course: Surgery
Keywords: Craniopharyngioma gender age location tumor size tumor grade hypothalamus radical resection radiotherapy quality of life
CLC: R739.4
Type: PhD thesis
Year: 2011
Downloads: 39
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Section One An analysis of clinical materials for patients with craniopharyngiomasObjective To explore and analyze the distribution of craniopharyngiomas by age and gender, the proportion of different tumor size, nature, location, preoperative MR imaging tumor grade according to the involvement of hypothalamus, imaging characteristics and symptoms. Estimate the validity of our data by comparison with other clinical materials in order to evaluate the surgical results and choose the treatment modality.Methods We retrospectively review the clinical materials of 214 patients with craniopharyngiomas which underwent surgical treatment in our hospital. All patients were confirmed by pathology postoperative. The tumor was categorized by various types. We analyzed the following contents:gender distribution, age distribution at surgery, symptoms, tumor size, location, nature, CT /MR imaging characteristic and preoperative MR imaging tumor grade according to the involvement of hypothalamus.Results There were 130 males (60.7%) and 84 females (39.3%). The mean age at the time of surgery was 29.0±17.3 years (median 27 years, range 21 months-68years). There were 71 patients (33.2%) younger than 16 years and 143 (66.8%) over 16 years. There were 189 (88.3%) primary tumors and 25 (11.7%) recurrent tumors (including 3 tumors underwent the second recurrence). Of the 25 recurrent tumors,20 (80%) underwent craniotomies previously,2 underwent craniotomies plus gamma knife surgery, one patient received gamma knife surgery. Ommaya reservoir implantation and cyst evacuation with gamma knife surgery were performed in one patient, respectively.The most common complaints were related to increased intracranial pressure, visual impairment and endocrine dysfunction. Headache was present in 130 (60.7%) patients, visual impairment in 126 (58.9%), endocrine dysfunction in 48 (22.4%). The duration from presentation to surgery was 1.5 years (median 6 months, range 3 days- 20 years).Of all the tumors,61 (28.5%),133 (62.2%) and 20 (9.3%) were cystic, mixed and solid, respectively. Hydrocephalus was present in 69 (32.2%) patients. Calcification was observed in 160 (74.8%) patients. The mean tumor size available in 133 patients was 3.85±1.05cm (range 2-7cm). One hundred and four (48.6%) tumors were located in the suprasellar,43 (20.1%) in the intra- and suprasellar,48 (22.4%) in the intra- and extraventricular,12 (5.6%) in the supra- and parasellar,4(1.9%) in the intraventricular, and 3 (1.4%) in the intrasellar. The stratification according to the degree of hypothalamic involvement was available in 140 patients. Grade 0 was present in 25 patients, Grade 1 in 63, and Grade 2 in 52.Conclusion The results obtained from the clinical materials were similar to the results of a large series of literatures. The data were objective and believable. Section Two An analysis of related factors of surgical results for patients with craniopharyngiomasObjective The optimal treatment modality for cranipharyngiomas remains controversial. The objective of this study was to retrospectively review the surgical results following gross total resection and partial resection with or without radiotherapy for craniopharyngiomas and analyze the related factors of surgical results.Methods From January,1994 to July,2009,214 patients underwent 219 procedures for craniopharyngiomas. We retrospectively reviewed the preoperative data of patients. There were 130 males (60.7%) and 84 females (39.3%). The mean age at the time of surgery was 29.0±17.3 years (median 27 years, range 21 months-68years). The purpose of surgery was gross total resection. Pterional approach was performed in 207 procedures. Nine patients underwent transcallosal approach and two patients received combined approach. One patient underwent retrosigmoid approach because the tumor was located in saddle area and main body extended to cerebellopontine angle. We followed the related postoperative information and analyzed the related factors of surgical results.Results Of all the 219 procedures, gross total resection and limited resection were achieved in 154(70.3%) and 65(29.7%) procedures, respectively. There were 11 perioperative deaths. The perioperative mortality was 20.9% (9 in 43 patients) in patients with hyperpyrexia, and 1.2% (2 in 171 patients) in patients without hyperpyrexia. There was statistic difference in the perioperative mortality between them (P<0.01). Of all these patients,151 were followed from 6 months to 190 months (mean 5.2±3.7 years). Of the 106 patients who underwent gross total resection,37 received conventional radiotherapy. Of the 45 patients who underwent limited resection,27 received conventional radiotherapy and 5 received gamma knife surgery.Tumor-related mortality is 12.6%(19 in 151 patients) during follow-up. Old patients, recurrent tumors and partial resection were risk factors for long term survival. Tumor recurrence occurred in 8.1%,10.1%,31.3%, and 92.3% of the patients who underwent gross total resection with radiotherapy, gross total resection with observation, limited resection with radiotherapy, limited resection with observation, respectively. There was no statistic difference in recurrence rate between patients who underwent gross total resection with and without radiotherapy. The recurrence rate in patients who underwent gross total resection with or without radiotherapy was higher than those who underwent limited resection with radiotherapy. There was also statistic difference in recurrence rate between patients following limited resection with and without radiotherapy. The mean duration from surgery to tumor recurrence following gross total resection was longer than duration following limited resection. Preoperative MR imaging tumor grade negatively correlated with the postoperative quality of life.Conclusion The preoperative CT/MR imaging provides clues of the relationship between tumor and surrounding structures. Gross total resection should be achieved in the treatment of craniopharyngiomas on the precise that hypothalamus was protected. The patients who undergo limited resection should receive conventional radiotherapy or gamma knife surgery.

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