基于QST分型的原发性颅咽管瘤神经内镜手术治疗经验

doi:10.3969/j.issn.1672-6731.2020.04.006

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (4): 281-288. doi: 10.3969/j.issn.1672-6731.2020.04.006

2 基于QST分型的原发性颅咽管瘤神经内镜手术治疗经验

樊俊, 刘忆, 冯展鹏, 潘军, 彭玉平, 彭俊祥, 聂晶, 漆松涛

510515 广州, 南方医科大学南方医院神经外科

收稿日期:2020-04-11 出版日期:2020-04-25 发布日期:2020-04-24
通讯作者: 漆松涛,Email:qisongtaosjwk@163.com
基金资助:
广东省自然科学基金资助项目（项目编号：2016A030310377）；广东省省级科技计划项目（项目编号：2016A020213006）；广东省省级科技计划项目（项目编号：2017A020215048）；广东省省级科技计划项目（项目编号：2017A020215191）；广东省广州市科技计划项目（项目编号：201707010149）；南方医科大学南方医院院长基金资助项目（项目编号：2015C018）；南方医科大学南方医院院长基金资助项目（项目编号：2016L002）；南方医科大学南方医院院长基金资助项目（项目编号：2016B006）；南方医科大学南方医院院长基金资助项目（项目编号：2017Z009）

Endoscopic endonasal surgery for resection of primary craniopharyngioma based on QST classification

FAN Jun, LIU Yi, FENG Zhan-peng, PAN Jun, PENG Yu-ping, PENG Jun-xiang, NIE Jing, QI Song-tao

Department of Neurosurgery, Nanfang Hospital, Southern Medial University, Guangzhou 510515, Guangdong, China

Received:2020-04-11 Online:2020-04-25 Published:2020-04-24
Supported by:
This study was supported by the Natural Science Foundation of Guangdong Province, China (No. 2016A030310377), the Science and Technology Program of Guangdong Province, China (No. 2016A020213006, 2017A020215048, 2017A020215191), the Science and Technology Program of Guangzhou, Guangdong Province, China (No. 201707010149), and the President Foundation of Nanfang Hospital, Southern Medical University (No. 2015C018, 2016L002, 2016B006, 2017Z009).

摘要/Abstract

摘要：

目的探讨基于QST分型的颅咽管瘤神经内镜下经鼻蝶入路手术的有效性和安全性，旨在为颅咽管瘤手术入路的选择提供依据。方法纳入2008年1月至2018年1月共125例原发性颅咽管瘤患者（包括Q型38例、S型20例和T型67例），均行神经内镜下扩大经鼻蝶入路手术，记录肿瘤全切除率、术后并发症和复发率。结果 Q型、S型和T型颅咽管瘤患者的手术全切除率分别为97.37%（37/38）、90%（18/20）和92.54%（62/67）；术后视力减退发生率为0（0/38）、5%（1/20）和1.49%（1/67），新发垂体功能减退症发生率为28.95%（11/38）、25%（5/20）和37.31%（25/67），永久性尿崩率发生率为39.47%（15/38）、35%（7/20）和44.78%（30/67），脑脊液鼻漏发生率为10.53%（4/38）、10%（2/20）和10.45%（7/67），颅内感染发生率为5.26%（2/38）、5%（1/20）和7.46%（5/67），脑积水发生率为5.26%（2/38）、5%（1/20）和5.97%（4/67），脑卒中发生率为2.63%（1/38）、5%（1/20）和2.99%（2/67），鼻腔并发症发生率为7.89%（3/38）、10%（2/20）和10.45%（7/67）；病死率分别为0（0/38）、5%（1/20）和2.99%（2/67）。平均随访71.60个月，肿瘤复发率分别为2.63%（1/38）、5%（1/20）和4.48%（3/67）。结论颅咽管瘤有望通过积极手术全切除治愈。神经内镜下经鼻蝶入路手术在处理不同QST分型肿瘤时具有独特优势，可取得良好疗效。基于鞍区膜性结构的概念和肿瘤生长模式的个体化手术策略对获得最佳预后具有重要意义。

关键词: 颅咽管瘤, 神经内窥镜检查, 神经外科手术

Abstract:

Objective The aim of this study was to evaluate outcomes of endonasal approaches for different craniopharyngiomas types based on QST classification. Methods A total of 125 primary craniopharyngioma (CP) patients undergoing resection from January 2008 to January 2018 were reviewed. All tumors were divided into three types (Q-, S-, and T-CP) according to QST classification:38 cases with Q-CP, 20 with S-CP, and 67 with T-CP. All tumors were removed by endoscopic endonasal surgery. The gross total resection rates, the postoperative complications and the recurrence rates were recorded. Results The gross total resection rates of Q -, S -, and T-CP were 97.37% (37/38), 90% (18/20) and 92.54% (62/67), respectively. Visual deterioration after surgery occurred in 0 (0/38), 5% (1/20) and 1.49% (1/67) of patients. The new hypopituitarism rates were 28.95% (11/38), 25% (5/20), and 37.31% (25/67), respectively; the permanent diabetes insipidus were observed in 39.47% (15/38), 35% (7/20) and 44.78% (30/67) of patients; postoperative cerebrospinal fluid leak occurred in 13 patient, with the rate of 10.53% (4/38), 10% (2/20) and 10.45% (7/67) in each tumor type; intracranial infection occurred in 5.26% (2/38), 5% (1/20) and 7.46% (5/67) of patients; hydrocephalus was noted in 5.26% (2/38), 5% (1/20) and 5.97% (5/67) of patients; Stroke or hemorrhage occurred in 2.63% (2/38), 5% (1/20) and 2.99% (2/67) of patients; nasal complications occurred in 7.89% (3/38), 10% (2/20) and 10.45% (7/67) of patients. The mortality was 0 (0/38), 5% (1/20) and 2.99% (2/67), respectively. The mean follow-up duration of all cases was 71.60 months, and the recurrence rate of each tumor type were 2.63% (1/38), 5% (1/20) and 4.48% (3/67), respectively. Conclusions Craniopharyngioma could be effectively cured by radical surgery. Endonasal surgery has its unique advantages when managing different types of craniopharyngioma with favorable results. Individualized surgical strategies based on tumor growth patterns are mandatory to achieve optimal outcomes of patients.

Key words: Craniopharyngioma, Neuroendoscopy, Neurosurgical procedures

樊俊, 刘忆, 冯展鹏, 潘军, 彭玉平, 彭俊祥, 聂晶, 漆松涛. 基于QST分型的原发性颅咽管瘤神经内镜手术治疗经验[J]. 中国现代神经疾病杂志, 2020, 20(4): 281-288.

FAN Jun, LIU Yi, FENG Zhan-peng, PAN Jun, PENG Yu-ping, PENG Jun-xiang, NIE Jing, QI Song-tao. Endoscopic endonasal surgery for resection of primary craniopharyngioma based on QST classification[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(4): 281-288.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I4/281

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