Analyses Of Long-term Results Of The Microsurgery Of Craniopharyngioma

Object:The optimal management of craniopharyngioma remains controversial. To explore the optimal operation strategy, this dissertation analyzes the differences in long-term results between different therapeutic outcomes (total resection, preservation of pituitary stalk or not) in a continuous series of patients who have undergone resection of craniopharyngioma.Methods:A retrospective analysis and long-term follow-up were performed in168consecutive patients who underwent microsurgery of craniopharyngioma performed by the same senior surgeon between2003and2012. The patients’ general information and operation data, especially the extent of resection and involvement of pituitary stalk (PS), were recorded. During the follow-up, the status of survival, tumor progression, endocrine, metabolism, visual outcomes and quality of life were noted and the factors related to them were analyzed.Results:Among the168patients,156patients (92.9%) received gross-total resection (GTR), including32patients (20.5%) whose pituitary stalks were preserved.2patients died during the perioperative period (1.2%).17patients were lost to follow-up. Thus, the follow-up data were obtained on151patients. The average follow-up time is46.4months and the five-year overall survival (OS) rate is90.2%. Cox shows that the mortality risk of the patients who didn’t receive GTR is4.7times that of the patients who received GTR. Meanwhile, the mortality risk of the female is4.2times that of the male.By the end of the follow-up,14patients had tumor progression. The five-year progression-free rate is90.2%and the five-year progression-free survival (PFS) rate is83.1%. Cox model reveals that the recurrent risk of the patients who didn’t receive GTR is9.4times that of the patients who received GTR. And the recurrent risk of the patients whose tumor originated from intra-seller is4.2times that of the patients whose tumor originated from PS.In our series, the group with preserved pituitary stalks has a higher long-term survival rate (100%) than the group without (86.8%), but there is not statistical difference in their tumor progression rates (P=0.325).In endocrine, hypothalamus-pituitary-adrenal (HPA) axis, hypothalamic-pituitary-thyroid (HPT) axis, hypothalamic-pituitary-gonadal (HPG) axis, growth hormone (GH), prolactin (PRL) and diabetes insipidus (DI) had different degrees of abnormities before and after operation, and they were impacted by surgery to different extent. The abnormal rate is27.6-78.9%before operation but51.6-89.2%in the late postoperative period. The rates of new abnormalities range from33.3%to77.1%and the improvement rates are between0and28.9%. Obvious rises in the abnormal rates are detected only in HPA, HPT and GH between the preoperative period and the late postoperative period (P<0.05). With the corresponding hormone axes being normal before the operation, the normal rate of the group with preserved PSs is higher than that of the patients whose PSs were resected.In terms of metabolic function, overweight occurs in32.5%of the patients, and obesity10.4%. There are significant rises in the laboratory indexes of blood glucose, triglyceride and cholesterol. In repeated measures analysis of variance,"the extent of resection" and "the management of PS" as the main intervention are not statistically significant.The abnormal rates of visual acuity in the late postoperative period (45.6%) do not change significantly compared with that before operation (47.1%). Meanwhile, the rate of abnormality of visual field in the late postoperative period (70.6%) has a significant increase (P=0.005).KPS classification reveals that the quality of life after resection of craniopharyngioma was good or excellent in82.1%of the cases; the patients who received GTR (average score:76.6) have better performance than the patients who didn’t (average score:41.8)(P<0.001); there is no significant difference (P=0.085) in KPS of the late postoperative period between the patients with their PSs preserved and the ones without (the average scores were82and73.1, respectively).Conclusions:1Gross-total resection of craniopharyngioma makes positive contribution to the improvement of long-term survival, tumor progression-free rate and quality of life.2Preservation of the PS which shows no tumor infiltration under the microscope does not increase the risk of tumor progression. Patients with a preserved pituitary stalk show better neuroendocrine functions to some degree, but the precondition is that the pre-operative endocrine functions are not completely destroyed. Preservation of PS benefits the patients’long-term survival and quality of life after the operation.3The patients whose PSs were resected for the need of radical treatment, have a low recurrence rate, and show no significant differences in metabolism and quality of life with the patients with their PSs preserved.