The Dependability Of The Preoperative MRI Evaluation Score Of Craniopharyngiomas And Therapeutic Effect Of The Operation

Objective: To scale the max diameter of craniopharyngiomasand the invasive extent that tumors involved in the third ventricle,and evaluate the contribution of the scale outcome to the theincidence rate of post-operative complications and the degree oftumor total removal, thus to instruct the operation and post-operativetreatment.Methods: We retrospectively analyzed 50 cases and data ofcraniopharyngioma operating treatment from year 2003 to 2005 inthe department of Neurosurgery in the 1st Hospital of JilinUniversity. All the patients were diagnosed via CT and MRIexaminations and the final diagnosis were based on the standard ofpathohistology. The evaluation scales were proposed according tothe following standard. Referring to the grouping method by Yasargil,the craniopharyngioma is divided into 4 types: minor-sized (≤2cm),media-sized (>2cm, ≤ 4cm), macro-sized (>4cm, ≤ 6cm) andgiga-sized (>6cm) according to the max diameter ofcraniopharyngioma and MRI outcomes. It can also be divided intoIV levels on the basis of the relationship betweencraniopharyngiomas and the third ventricle. Level 1: the thirdventricle is involved or slightly involved, the recessus chiasmatis andthe infundibular recess can be seen clearly. Level 2: tumors compressthe antero-inferior part of the third ventricle, the normal structure ofthe recessus chiasmatis and infundibular recess dissapeared, thebasal part of the third ventricle raise but not surpass theinterventricular foramen level. Level 3: the tumors occupy most orall parts of the third ventricle, or even involved in the lateralventricle. Level 4: the juncture of tumors and the antero part of thethird ventricle exists massive calcified plaque and obviouslyintensive image and the tumors grow invasively involved in thestructure of hypothalamus. These 50 cases were divided into 3groups according to the scale: Group A (0~2 grade),Group B(3~4grade),Group C(5~6 grade)。43 cases adopted the pterion approach,6 cases adopted the infer-frontal approach, and 1 adopted thesphenoid approach. All of them used microsurgery techniques toresect the tumors. Record the Na+ concentration that day of theoperation and examine the post-operative Na+ concentration each day,observe and record the urine volume change each day. Analyze thestatistic variability in the aspects of the post-operative degree oftumor resection, death rate, Na+ derangement and diabetes insipidusin different groups using the statistics methods.Result: Craniopharyngioma of 42 cases were total removal, 8cases were partial resected. In these 8 cases, except 2 cases in GroupB, the rest of the 6 were all in Group C. The 3 dead cases were GroupC cases. 36 cases have Na+ derangement after operation (72.0%), 17cases of which have slightly Na+ derangement, 19 of which havesevere Na+ derangement. 13 cases only have hyponatremia, 15 casesonly have hypernatremia and 11 cases have both hypernatremia andhyponatremia after operation. 45 cases have post-operative diabetesinsipidus (90%), including 27 cases of lower grade diabetes insipidus,10 cases of media grade diabetes insipidus and 8 cases of severediabetes insipidus. In the mean time, the statistics indicate that thehigher the scale the more difficulty to accomplish total removal, anda worse clinical outcome, which has the statistic difference;and thescale has the statistic difference with the Na+ derangement and thedegree of diabetes insipidus.Conclusion: The scale of the two aspects: the max diameter ofcraniopharyngioma and the relationship between tumors and the thirdventricle were negatively related to the degree of tumor total removal,and positively related to the incidence rate of post-operativecomplications like ionic derangement and diabetes insipidus. Wecould consider that before operation, the analysis of the MRIoutcomes of the craniopharyngioma max diameter and therelationship of tumors and the third ventricle may help us anticipatethe degree of tumor total removal and degree of the hypothalamicreaction after operation. This means that it requests the surgeons tocomplete the image examinations, carefully analyze the MRIoutcomes before operation, choose proper approaches, and estimatethe probable hypothalamic reaction after operation. All of them arepropitious to select the right treatment after operation, thus toimprove the overall therapeutic effect.