Abstract
It is widely reported that complete tumor resection is the most certain method for successful radical craniopharyngioma resection. However, radical resection and endocrinic function preservation are often opposing goals in craniopharyngioma surgery. Also, as for the context of “total removal”, there are no reports that clearly examine the complete total removal method with pathological specimens. Therefore we discuss radical resection that has a high curative rate from the view point of long-term prognosis in our experiences.
Between 1991 and 2012, 57 patients underwent surgery for craniopharyngioma in 71 instances at our institution. The follow-up period ranged from 6 months to 21 years (mean 8.4 years). We aimed to remove the tumor totally in almost all cases with a combined supra-and infra-chiasmatic approach or orbitozygomatic multi-trajectory approach. Although the surgical approach should be deliberately selected in order to obtain a better view of the tumor origin and to preserve this axis anatomically priority should be given to radical resection when functional preservation is considered to be impracticable.
For many of the non recurrent cases we partially perforated the hypothalamus and removed the tumor totally with the pituitary stalk and gland in recent years, but in a few of the non recurrent cases we removed the tumor totally while preserving the pituitary stalk and gland. So almost all of the non recurrent cases required hormone replacement postoperatively independent of whether we preserve the pituitary stalk and gland or not. The feasibility of functional preservation of the hypothalamic-pituitary axis is determined primarily by the exact site of tumor origin, i. e. proximal or distal to the hypothalamus-pituitary stalk junction. Finally for the purpose of attaining truly radical resection of the tumor, intraoperative frequent and frozen histopathological examination is mandatory to confirm that accurate surgical margins have been obtained.
