| Objective:To discuss the clinical curative effect of different microsurgical approach of treatment of craniopharyngima,and analysis the statistical difference of five different operative approaches and the maximal diameter of tumor.Methods:Weretrospectively reviewed63cases of craniopharyngiomafromJanuary2012to December2014in The Second Affiliated Hospital, School of Medicine, Zhejiang University. All the patients received microsurgical treatment. The operations was performed via lateral orbital approach in8cases, transsphenoidalapproach in10cases (endoscope-assisted in3cases), pterion approach in12cases, subfrontal approach in14cases, and anterior longitudinal approach in19cases. According to the maximal diameter of tumor, we divided the cases into3group, less than3cm in26cases,3to5cm in30cases, and greater than5cm in7cases.By collecting clinical materials, include clinical manifestations, imaging findings, choice of surgical approach, surgical resection, and the clinical data of postoperative complications, analysis the microsurgical treatment effect of craniopharyngioma.SPSS19.0on dataprocessing,andt test analysis differences between group, age, and gender, and chi-square analysis differences between tumor whole cutting rate and postoperative complications.Results:1. Differences in Gender, age, and tumor size indifferent microscopic surgical approach group had no statistical significance. The differences in genderand age in different tumor size group had no statistical significance.2. All63patients underwent surgery, and3patients died after operation.Tumor complete resection in37cases (58.7%), sub-total resection in15cases (23.8%), and subtotal resection in11cases (17.5%).Among them, the lateral orbital approachcomplete resection in5cases of8cases (62.5%), thetranssphenoidal approach complete resection in7cases oflO cases (70%), pterion approach complete resection in7cases ofl2cases (58.3%), the subfrontal approach complete resection in7cases of14cases (50%), and the anterior longitudinal approach complete resection in llcasesof the19cases (57.9%).Five different surgical approaches were analyzed, and the rate of tumor complete resectionhad no statistical difference(X2=1.02, P>0.05).3.43patients in63cases(68.3%)had postoperative complications, including diabetes insipidus, sodium metabolism disorders or central high fever, etc.Among them, the lateral orbital approachgroup’s postoperative complications in6cases of8cases(75%), thetranssphenoidal approachgroup’s postoperative complications in6cases of10cases (60%), the pterion approach group’s postoperative complications in7cases of12cases (58.3%), the subfrontal approach group’s postoperative complications in10cases of14cases (71.4%), and the anterior longitudinal approachgroup’s postoperative complication in the14cases of14cases (73.3%).Five different surgical approaches were analyzed, and the incidence of postoperative complications had no statistical difference(X2=1.35, P>0.05). 4. Among63cases, tumor maximum diameter<3cm group’s complete resection in20cases of26cases (76.9%).Tumor maximum diameter3to5cm group’s complete resectionin16cases of30cases (53.3%). Tumor maximum diameter>5cm group’s complete resectionin1cases of7case (14.3%).Different rate of complete resection in different tumor maximum diameter groupshad statistically difference;The largertumor, the lower rate of complete resection (X2=9.62, P=0.008<0.05).5. Among63cases, tumor maximum diameter<3cm group’s postoperative complications in17cases of26cases (65.4%). Tumor diameter3to5cm group’s postoperative complications in23cases of30cases (76.7%). Tumor maximum diameter>5cm group’s postoperative complications in3cases of7cases (42.9%).Differenttumor maximum diameter group’s incidence of postoperative complications had no statistical difference (X2=3.16, P>0.05).Conclusions:1. Microsurgicalresection is the main and effective way in the treatment of craniopharyngioma.Preoperative evaluation, choice of microsurgical approach, and intraoperative tumor exposure, effect to surgical resection.2. Craniopharyngioma operation easy damage near important structure, lead to high incidence of postoperative complications, including diabetes insipidus and electrolyte disorders in the most rare. Prevention and treatment of postoperative complications affectpatients’quality of life.3. Effect of different surgical approaches to tumor excision and the incidence of postoperative complications have no obvious difference in statistics.4. Tumor maximum diameter affects the surgical complete resection, the larger tumor diameter, the lower rate of complete resection;the incidence of postoperative complications in different tumor sizes had no obvious differences in statistics. |
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