Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients
Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients
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DOI：
10.1097/00006123-199905000-00012
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发表时间：
1999-05-01
期刊：
影响因子：
4.8
通讯作者：
Lüdecke, DK
中科院分区：
文献类型：
--
作者：
Abe, T;Lüdecke, DK
目的：经鼻手术仅在少数儿童颅咽管瘤病例中进行，其疗效仍存在争议。方法：我们分析了11例儿童经鼻手术的结果（6名男性和5名女性患者），手术时年龄小于15岁，患有颅内颅咽管瘤（年龄范围，7.7-14.9岁），并在1985年至1996年期间接受治疗，当时有更精确的诊断和手术技术。其中两名患者在其他地方接受了初次手术。选择经鼻入路是因为鞍区扩大和鞍下肿瘤的存在。临床随访期的持续时间至少为1 year.Results：5例患者需要钻不完全的蝶窦达到鞍，但在任何情况下，与患者年龄或正弦相关的解剖差异被认为是经鼻手术的限制因素。8例患者（72.7%）均切除了正常垂体，以暴露背侧肿瘤。这种外科手术从未引起任何重大的功能损害垂体前叶。3名患者（27.3%）实现肿瘤完全切除，8名患者（72.7%）实现肿瘤次全切除。23例患者中，22例（95.7%）在肿瘤次全切除后保留了正常功能。相反，在肿瘤完全切除后，只有四种正常功能中的一种得以维持。1例患者在肿瘤全切除术后发生持续性尿崩症。2例患者发生肿瘤再生长。随访期间未观察到肿瘤复发。结论：根据目前的研究结果，经鼻手术似乎是指大多数发生在儿童患者的颅内颅咽管瘤。经鼻手术在儿科患者中进行与在成人患者中一样安全。在保留垂体功能的情况下，肿瘤次全切除的概念，避免了对下丘脑结构的损伤和过多的脑脊液漏，似乎是合理的儿科患者。
OBJECTIVE: Transnasal surgery has been performed in only a small number of cases of pediatric craniopharyngiomas, and its efficacy is still a matter of debate.METHODS: We analyzed the results of transnasal surgery performed in 11 pediatric patients (6 male and 5 female patients) with infradiaphragmatic craniopharyngiomas who were younger than 15 years at the time of surgery (age range, 7.7-14.9 yr) and who were treated between 1985 and 1996, when more refined diagnostic and surgical techniques were available. Two of the patients had undergone primary surgery elsewhere. The transnasal approach was chosen because of sellar enlargement and the presence of an infradiaphragmatic tumor. The duration of the clinical follow-up period was at least 1 year.RESULTS: Five patients required drilling of incompletely pneumatized sphenoid sinuses to reach the sella, but in no cases were the anatomic differences related to patient age or sine thought to be a limiting factor in the transnasal procedure. The normal pituitary gland was incised to expose a dorsally located tumor in each of eight patients (72.7%). This surgical procedure has never provoked any major functional damage to the anterior pituitary gland. Complete tumor resection was achieved in three patients (27.3%) and subtotal removal in eight (72.7%). Twenty-two (95.7%) of 23 normal functions were preserved after subtotal tumor removal. In contrast, only one of four normal functions was maintained after complete tumor resection. Persistent diabetes insipidus occurred after total tumor resection in one patient. Tumor regrowth occurred in two patients. No tumor recurrence was observed during the follow-up period.CONCLUSION: Based on the present findings, transnasal surgery seems to be indicated for most infradiaphragmatic craniopharyngiomas occurring in pediatric patients. Transnasal surgery is as safe to perform in pediatric patients as it is in adult patients. The concept of subtotal tumor removal with preservation of pituitary function, avoiding damage to hypothalamic structures and excessive cerebrospinal fluid leakage, seems to be justified in pediatric patients.