Surgical Operation And Interferon Treatment Of Primary Pediatric Craniopharyngioma And Analysis Of Its Efficacy

Objectives: To explore the safety and effectiveness of traditional surgery and stereotactic assisted IFN-? intracapsular injection in the treatment of primary pediatric craniopharyngioma,analyze and compare the respective advantages of the two treatment methods,and provide a concrete reference for the treatment of primary pediatric craniopharyngioma.Methods: 152 cases of newly diagnosed pediatric craniopharyngioma who were treated at the Institute of Neurosurgery of the Sixth Medical Center of the General Hospital of Chinese People's Liberation Army from January 1,2010 to December 31,2019.Summarize the clinical and imaging characteristics of all above children.53 patients meet the surgical resection and interferon treatment capsule inclusion and exclusion criteria,and compared its short-term and long-term effect of postoperative.Results: The clinical characteristics of 152 cases of newly diagnosed children with craniopharyngioma were summarized in detail.There were 89 males and 63 females,with an average age of onset of 7.63 years and a high incidence of 4-6 years.The average time from the first symptoms to the definite diagnosis was 10.57 months.At the time of initial diagnosis,cranial hypertension syndrome accounted for 35.5% ranking first in symptoms.And there were differences in the incidence of subjective and objective clinical symptoms and signs,especially in terms of visual impairment,growth retardation and body development.The calcification rate was up to 94.1%.MRI showed that the tumor in the main sign of long T1,T2(65.1%),cystic majority(71.1%),mainly in the saddle region(34.2%),can be extended to different sites along the tissue space.Fifty-three patients met the inclusion criteria for surgery and interferon intravesical chemotherapy,36 patients underwent surgical resection and 17 patients received interferon intravesical chemotherapy.The pterionalcraniotomy was the main approach(83.3%),with the rate of GTR of 58.3%,and the pathology was only adamantinomatous.The 3-year and 6-year OS rates were 72.3% and47.3%,as well as 3-year and 6-year PFS rates were 52.8% and 27.8%,respectively.The tumor recurrence rate was 30.6%.However,the rate of complication is high,such as cerebral hemorrhage(16.7%),intracranial infection(25%),polydipsia and polyuria(46.9%),pituitary dysfunction(54.2%),water and electrolyte disorders(83.3%),etc.,and long-term intellectual learning disabilities and abnormal pituitary hormones significantly increased.Interferon chemotherapy is mainly applicable to cystic craniopharyngioma.Stereotactic assisted cystic cavity catheterization is a necessary link before treatment.15 patients underwent Ommaya capsule implantation,and the right cranial point(70.6%)was the main point of entry.The positive rate of cholesterol crystals was 64.7%.There were no severe complications such as cerebral hemorrhage,intracranial infection,and secondary severe hypothalamic-pituitary dysfunction during the perioperative period.The main side effects of the medicine during the treatment were low fever(41.2%),high fever(17.6),fatigue and weakness.All achieved complete remission after single treatment.Most children received only 1 course of chemotherapy(47.1%),and at most one case received 5 courses of treatment,with a large difference in efficacy.One patient received 4 courses of treatment obtained longer PFS(3.67 years).The OS rates at 3 and 6 years after treatment were 53% and 5.9%,the PFS rates at 3 and6 years were 11.8% and 0%.The tumor recurrence rate was 70.6% during the follow-up period.Compared with the two treatment groups,there was no significant difference in the improvement of short-term clinical symptoms.However,surgery is more advantageous in controlling tumor progression and delaying survival.But the surgical trauma is large and the incidence of postoperative complications is high,which seriously affects the long-term quality of life of children.Interferon chemotherapy has less trauma and fewer complications,and prolongs tumor progression to a certain extent,but the effect is uncertain.Conclusions: Surgery can effectively control tumor progression and prolong survival,but it has a high incidence of short-term and severe long-term complications,which affects the quality of life of children.The safety of interferon intravesical chemotherapy is positive,the long-term and short-term complications are few,and the tumor progression is delayed to some extent,but there are individual differences.Whether long-term efficacy is related to the course of treatment needs systematic prospective research.