Neurological and neuropsychological outcome after resection of craniopharyngiomas
Neurological and neuropsychological outcome after resection of craniopharyngiomas
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DOI：
10.3171/2018.10.jns181557
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发表时间：
2020-05-01
影响因子：
4.1
通讯作者：
Zweckberger, Klaus
中科院分区：
文献类型：
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作者：
Giese, Henrik;Haenig, Benjamin;Zweckberger, Klaus
目的颅咽管瘤是一种罕见的鞍区和鞍旁区良性肿瘤。主要治疗包括切除后辅助放疗。虽然手术后经常分析切除的程度，但神经预后，特别是神经心理缺陷和生活质量几十年来一直被忽视。因此，作者回顾性分析了他们的患者系列，并前瞻性地评估了成人颅咽管瘤切除术后的神经心理结果和生活质量。方法回顾性分析71例患者（男39例，女32例），平均年龄49岁。此外，71名患者中的36名被纳入前瞻性研究组，并接受了神经学和神经心理学测试以及生活质量（36- item Short-Form Health Survey; SF-36）评估。确定影响结果的因素并计算相关性。结果：手术切除主要采用翼侧（41.6%,47/113）或双额侧经终板（30.1%,34/113）入路。术后32.4%（23/71）患者的视力明显改善（bb0 0.2）， 45.1%（32/71）患者的视力保持稳定。在长期随访中，80.3%（57/71）的患者出现垂体功能不全，尤其是促皮质轴和促甲状腺轴。75%（27/36）的患者在至少1项测试中出现神经心理偏差。尤其是注意力、认知速度和短期记忆受到了影响。参照SF-36评分，生活质量在精神和身体评分中分别受到19.4%（7/36）和33.3%（12/36）的影响。确定的危险因素是肿瘤体积大于9cm(3)，肿瘤向第三脑室或脑干扩展，以及采用双额经椎板终端机或左侧入路切除。结论：本研究表明颅咽管瘤切除术通常与术后神经心理功能障碍相关，从而影响患者的生活质量。除了肿瘤的大小和向第三脑室或脑干的扩展外，手术入路的选择可能对患者的神经心理结果和生活质量起着至关重要的作用。
OBJECTIVE Craniopharyngiomas are rare and benign tumors of the sellar and/or parasellar region. Primary treatment involves resection followed by adjuvant radiotherapy. While the grade of resection was frequently analyzed following surgery, the neurological outcome and especially neuropsychological deficits and quality of life have been neglected for many decades. Therefore, the authors retrospectively analyzed their patient series and prospectively assessed neuropsychological outcome and quality of life following resection of craniopharyngiomas in adults.METHODS In total, 71 patients (39 men and 32 women) with a mean age of 49 years were enrolled in the retrospective analysis. In addition, 36 of the 71 patients were included in the prospective arm of the study and underwent neurological and neuropsychological testing as well as quality of life (36-Item Short-Form Health Survey; SF-36) assessment. Factors influencing outcome were identified and correlations calculated.RESULTS Resection was performed mostly using a pterional (41.6%, 47/113 surgical procedures) or bifrontal translamina terminalis (30.1%, 34/113 surgical procedures) approach. Following surgery, visual acuity was significantly improved (> 0.2 diopters) in 32.4% (23/71) of patients, or remained stable in 45.1% (32/71) of patients. During long-term follow up, 80.3% (57/71) of patients developed pituitary insufficiency, particularly involving the corticotropic and thyrotrophic axes. In total, 75% (27/36) of patients showed neuropsychological deviations in at least 1 test item. In particular, attentiveness, cognitive speed, and short-term memory were affected. Referring to the SF-36 score, quality of life was affected in both the mental and physical score in 19.4% (7/36) and 33.3% (12/36), respectively. The risk factors that were identified were a tumor volume larger than 9 cm(3), tumor extension toward/into the third ventricle or the brainstem, and resection using a bifrontal translamina terminalis or left-sided approach.CONCLUSIONS This study demonstrated that resection of craniopharyngiomas is frequently associated with postoperative neuropsychological deficits and hence an impaired quality of life. In addition to tumor size and extension toward/into the third ventricle or the brainstem, selection of the surgical approach may play a crucial role in the patient's neuropsychological outcome and quality of life.