目的:扩大鼻入路(EEA)已成为切除颅咽管瘤的首选手术方法,由于其直接可视化和减少盲角的优点。然而,由于乳头状CPs(PCPs)的发生率较低,基于EEA方法的PCP的完整视图是有限的。在本文中,作者提出了迄今为止最大的系列研究,分析了基于EEA方法的PCP的临床特征.
方法:回顾性分析101例经鼻内镜手术(EEA)并经术后病理证实的PCPs患者。根据MRI数据和EEA的术中发现,PCP分为三种类型:鞍上/鞍内(3V底板完整)类型(I型),鞍上/鞍内(3V底板侵入性)型(II型),和第三脑室型(III型)。总结了三种类型肿瘤的一般特点,术后随访记录视力变化的详细信息,内分泌替代,肿瘤复发,和生活质量。
结果:在101例中,36人(36.64%)被归类为I型,52(51.49%)为II型,和13(12.87%)为III型。III型患者平均年龄为40.46±14.15岁,比其他两种类型年轻(p=0.021)。头痛(84.62%)和记忆力下降(61.54%)是III型患者的突出特征(p=0.029)。视力障碍在II型中更为常见(80.77%,p=0.01)。91例患者(90.10%)实现了总切除术(GTR)。三种类型的肿瘤之间的GTR率没有显着差异。3种PCP患者的生活质量差异有统计学意义(p=0.004),根据KPS评分,III型患者的术后生活质量最高(92.31%)。13例(12.87%)肿瘤在38例平均随访时间内复发(范围,8-63)个月。II型PCPs(OR5.826,95CI1.185-28.652,p=0.030)和复发患者(OR4.485,95CI1.229-16.374,p=0.023)被证实是肿瘤复发的独立危险因素。
结论:大多数PCP包括第三脑室内PCP可以通过EEA神经内镜安全有效地去除。与其他两种类型相比,鞍上/鞍内(第三脑室底侵入性)类型的PCP可能具有更差的术后生活质量,它可能是肿瘤复发的有力预测因子。
OBJECTIVE: The enlarged endonasal approach (EEA) has emerged as the preferred surgical procedure for removing craniopharyngiomas, due to its advantages of direct visualization and reduction of blind corners. However, owing to a low incidence of papillary CPs (PCPs) compared to adamantinomatous CPs (ACPs), a full view of PCP based on the EEA approach is limited. In this paper, the authors present the largest series to date analyzing the clinical characteristics based on the EEA approach for PCPs.
METHODS: A retrospective review was conducted on 101 PCPs patients who underwent endoscopic endonasal surgery (EEA) and whose condition was confirmed via postoperative pathology. The PCPs were classified into three types based on MRI data and intraoperative findings from EEA: suprasellar/intra-suprasellar (3V floor intact) type (Type I), suprasellar/intra-suprasellar (3V floor invasive) type (Type II), and intra-third ventricle type (Type III). The general characteristics of the three types of tumors were summarized, and postoperative follow-up was conducted to record detailed information on changes in vision, endocrine replacement, tumor recurrence, and quality of life.
RESULTS: Out of the 101 cases, 36 (36.64%) were classified as type I, 52 (51.49%) as type II, and 13 (12.87%) as type III. The mean age of type III patients was 40.46 ± 14.15 years old, younger than the other two types (p = 0.021). Headache (84.62%) and memory decline (61.54%) were prominent features in patients with type III (p = 0.029). Visual impairment was more common in type II (80.77%, p = 0.01). Gross total resection (GTR) was achieved in 91 patients (90.10%). There were no significant differences in GTR rates among the three types of tumors. There were significant differences in quality of life among the three types of PCP (p = 0.004), and type III presented with the highest rate of good postoperative quality of life (92.31%) based on the KPS score. Thirteen (12.87%) tumors recurred within a mean follow-up time of 38 (range, 8-63) months. Type II PCPs (OR 5.826, 95%CI 1.185-28.652, p = 0.030) and relapsed patients (OR 4.485, 95%CI 1.229-16.374, p = 0.023) were confirmed as independent risk factors for tumor recurrence.
CONCLUSIONS: Most of the PCPs including intra-third ventricle PCPs can be safely and effectively removed through neuroendoscopy with EEA. Suprasellar/intra-suprasellar (third cerebral ventricle floor-invasive) type PCPs may have a worse postoperative quality of life compared to the other two types, and it may be a strong predictor of tumor recurrence.