Artikel
Role of skull base surgery for the radical resection of craniopharyngioma
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Our policy of treatment of craniopharyngiomas is radical tumor resection even in cases with recurrent lesions. We focus on the efficiency of skull base approaches for the radical resection of craniopharyngioma.
Methods: 63 consecutive patients (mean age, 39.9 yr; range, 4–74 yr) with craniopharyngioma, including 22 patients with recurrence, underwent 91 procedures at Osaka City University Hospital from 1993 to 2011. The best surgical corridor was selected from several skull base approaches depending on the individual variation including the tumor size, location, consistency and its extension. Surgical approaches included the transpetrosal approach 31 times, the orbitozygomatic approach in 33, the transsphenoidal approach in 10 and the subfrontal interhemispheric/basal approach in 13 and others in 2. The length of the follow-up ranged from 5 to 216 months (mean, 112).
Results: Gross total removal (no residual enhancement) was accomplished in 40 patients (64%), near total resection (thin rim or spot enhancement) in 21 (33%) and subtotal removal in 2 (3%). The reasons for incomplete removal were mainly involvement of vascular structures. The part of the tumor that adhered to the inferior surface of the chiasm was completely resected in all patients. Overall operative morbidity except for endocrinological function was 10% (6 patients), including 3 patients with cognitive dysfunction and 3 patients with visual deterioration. The ophthalmological function was significantly improved after operation. Using the Kaplan-Meier analysis, the cumulative recurrent-free survival rate was 85.2% after 5 years and 78.1% after 10 years.
Conclusions: Our satisfactory results suggest that the use of the skull base approaches can render the improvement of surgical outcomes in properly selected patients with craniopharyngioma, even in cases of recurrence.