A Clinical Study Of Pituitary Stalk Management During The Microsurgery Of Craniopharyngiomas

Objective:To investigate the differences in recurrence rate and endocrine functions between the patients with preservation or resection of pituitary stalk by retrospective analysis of the patients (n=203), who were received microsurgery for craniopharyngioma combined with long-term follow-up. Besides, it was to investigate and summarize the possible guidelines of preservation or resection of pituitary stalk in microsurgery for craniopharyngioma.MethodsAnalysis of203cases of craniopharyngioma patients operated by the same professor was done in the past20years. Investigation of tumor origins and the conditions of preservation or resection of pituitary stalk during surgery was done. Since2010, the pituitary stalk, which was considered having a relationship with tumor, was detected by electron microscope in order to determine whether tumor cells existed or not. At the same time, long term follow-up was performed with the patients. Tumor recurrence or not, postoperative endocrine condition, visual acuity and visual field, as well as quality of life were all recorded and investigated. Then, comparison of the recurrence rate and endocrine function between the patients with preservation or resection of pituitary stalk was conducted.ResultsAmong the203patients,175patients received gross-total resection (GTR)(175/203,86.2%), and28patients underwent subtotal resection (STR)(28/203,13.8%). During the studying of all the203patients,25cases lost follow-up, thus they were not included in the data analysis. Four patients died during perioperative period (4/203,1.97%), and the others received follow-up.14patients showed recurrence during GTR group with157patients (14/157,8.9%), and7cases endured tumor regrowth during STR group with21patients (7/21,33.3%). There was significant difference in tumor progression between the two groups.5-year progression-free survival (PFS) was84.2%. During the studying of the203patients,165cases originated from pituitary stalk,36cases sourced from intrasellar regions, and2patients belonged to ectopic origin. Among those34patients underwent preservation of pituitary stalk (34/203,16.7%).157patients, who had GTR performed on and received follow-up, were analyzed. There was no significant difference in recurrence rate between the patients with preservation of pituitary stalk (4/34,11.8%) and resection of pituitary stalk (10/123,8.1%). Considering the effects of origins, during the157cases,128patients sourcing from pituitary stalk were chosen for study. There was also no significant difference in recurrence rate between the patients with preservation of pituitary stalk (1/19,5.3%) and resection of pituitary stalk (6/109,5.5%). As for91patients carrying endocrine data, in preservation of pituitary stalk group, the number of patients presenting endocrine functions with normal, better and poor conditions were5,18, and0, separately. However, during resection of pituitary stalk group, the number of patients showing endocrine functions with normal, better and poor conditions were1,60, and7, which had significant differences. The incidence of diabetes insipidus in preservation of pituitary stalk group (5/31) was significantly different from that in resection of pituitary stalk group (44/118).Pituitary stalk and micro-observation were performed on15patients using electron microscope. The unique structures of tumor cells of pituitary stalk were present in all the15patients.ConclusionsCombined with objective test results using electron microscope, all the pituitary stalk in resection were involved with tumor, and the standard was effective. However, this standard needs further inspection and study.As for the tumor originated from pituitary stalk, if the pituitary stalk was not completely lesioned with tumor, it could be carried out using remaining or partial remaining of pituitary stalk. In this way, the recurrence rate was not increased, but the patients could have better endocrine functions.